Case Report: COVID-19 with Bilateral Adrenal Hemorrhage

• Published in: The American journal of tropical medicine and hygiene Vol. 103; no. 3; pp. 1156 - 1157
• Main Authors: Álvarez-Troncoso, Jorge, Zapatero Larrauri, Miriam, Montero Vega, M Dolores, Gil Vallano, Rebeca, Palmier Peláez, Esmeralda, Martín Rojas-Marcos, Patricia, Martín-Luengo, Fátima, Lázaro Del Campo, Paula, Herrero Gil, Carmen Rosario, Trigo Esteban, Elena
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01-09-2020; The American Society of Tropical Medicine and Hygiene
• Subjects: Adrenal Gland Diseases - diagnosis; Adrenal Gland Diseases - etiology; Aged; Betacoronavirus; Case reports; Coronavirus Infections - complications; Coronaviruses; COVID-19; Hemorrhage - diagnosis; Hemorrhage - etiology; Humans; Male; Pandemics; Pneumonia, Viral - complications; SARS-CoV-2
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.20-0722

A 70-year-old Dominican Republic man presented with lower back pain for 10 days. Fifteen days before pain onset, he had low-grade fever, chills, and asthenia, and 4 days before admission, he had constipation, malaise, generalized weakness, anorexia, nausea, and vomiting. On admission, the patient was afebrile and hypotensive, with a heart rate of 105 and an oxyhemoglobin saturation on room air of 95%. Hyponatremia, lymphopenia, elevated C-reactive protein, and ferritin were observed in complementary tests. Computed tomography (CT) scan showed findings consistent with COVID-19 bilateral bronchopneumonia, and an increase in size and blurring (loss of the Y shape) of both adrenals indicative of acute bilateral adrenal hemorrhage. The patient tested negative by reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal swab, yet positive for IgG and IgM by ELISA, suggesting COVID-19 diagnosis.