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?:abstract
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Introduction: 29-year-old with common variable immunodeficiency, lymphangiomatosis, portal hypertension status post TIPS procedure was lost to follow up He was off gamma globulin and prophylactic antibiotics for fourteen months prior to presentation secondary to insurance issues Early February 2020 patient presented with abdominal distension and hemoptysis He denied fever, shortness of breath or additional respiratory symptoms Initial CT of chest showed basilar cavitary infiltrate Coronavirus PCR testing was positive, presumed SARS-CoV2 Immunoglobulin G level was 467 Case Description: He was started on empiric broad spectrum antibiotics, antifungals and immunoglobulin replacement He developed fever, worsening respiratory symptoms, and lower lobe infiltrates soon after admission Bronchoscopy was performed, and culture was positive for Aspergillus Blood culture was positive for Streptococcus Agalactiae Paracentesis, TIPS check with balloon dilation, and splenic artery aneurysm coiling were performed He developed thrombosis of greater saphenous vein and was started on anticoagulation He required oxygen supplementation, but not intubation Patient gradually improved and was discharged after seventeen days hospitalization He was continued on antibiotic, antifungal, and anticoagulation at discharge Outpatient follow up was arranged with Immunology, subcutaneous immunoglobulin was resumed, and he continues to clinically improve to baseline three months after discharge Discussion: The knowledge of SARS-CoV2 infections in patients with underlying Immunodeficiency is rapidly evolving Immunodeficiency has been speculated to protect against cytokine storm and hyper inflammation from COVID-19 Markers of cytokine storm were not measured during our patient’s admission However, despite coinfections and additional sequelae, our patient had no evidence of ARDS or requirement for prolonged respiratory support
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