COVID

Question 1:

What is the reason for  hypoalbuminemia in the patient?

Answer:

It may be due to pulmonary capillary leakage in lungs , in response to epithelial endothelial damage due to covid infection.

https://pubmed.ncbi.nlm.nih.gov/33411411/2. 

Question 2:

What could be the reason for exanthem on arms? Could it be due to covid-19 infection ?

Answer:

Yes, what the patient is experiencing is known as viral exanthem which is one of the cutaneous manifestation of COVID-19. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549735/

Question 3:

What is the reason for Cardiomegaly?

Answer:

The most probable cause of that appearance is AP view of the chest. When an anteroposterior view is taken, most times the CXR shows false cardiomegaly. To confirm the cardiomegaly a PA view of chest must be taken. 

Another possible cause can be Direct Myocardial Cell Injury. The interaction of SARS-CoV-2 with ACE2 can cause changes to the ACE2 pathways, leading to acute injury of the lung, heart, and endothelial cells. A small number of case reports have indicated that SARS-CoV2 might directly infect the myocardium, causing viral myocarditis. However, in most cases, myocardial damage appeared to be caused by increased cardiometabolic demand associated with the systemic infection and ongoing hypoxia caused by severe pneumonia or ARDS

https://www.ncbi.nlm.nih.gov/books/NBK556152/

Question 4:

What other differential diagnoses could be drawn if the patient tested negative for covid infection?

Answer:

Possible alternative diagnoses may include:

• Influenza

• Mycoplasma pneumonia

• Parainfluenza

• Respiratory syncytial virus

• Streptococcus pneumonia

• Other viral or bacterial pneumonia.

Question 5:

Why is there elevated D-Dimer in covid infection? What other conditions show D-dimer elevation?

Answer:

It is well known that D-dimer are produced during fibrin breakdown and serve as a marker of fibrinolytic activity. A relationship between proinflammatory cytokines and markers of activation of the coagulation cascade, including D-dimer, has been demonstrated in critical patients or patients with sepsis .There is also evidence that under inflammatory conditions, the alveolar haemostatic balance is shifted towards a predominance of prothrombotic activity .In addition, pro-inflammatory cytokines may be involved in endothelial injury, and may activate coagulation and inhibit fibrinolysis in patients with severe sepsis.

• D-dimer can be elevated such as in pregnancy, inflammation, malignancy, trauma, liver disease (decreased clearance), heart disease, sepsis or as a result of hemodialysis, CPR or recent surgery)