Newly diagnosed autoimmune Addison's disease in a patient with COVID-19 with autoimmune disseminated encephalomyelitis.
Newly diagnosed autoimmune Addison's disease in a patient with COVID-19 with autoimmune disseminated encephalomyelitis.
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DOI：
10.1136/bcr-2022-250749
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发表时间：
2022-12-05
期刊：
影响因子：
0.9
通讯作者：
Yang, Qin
中科院分区：
文献类型：
--
作者：
Beshay, Lauren;Wei, Kevin;Yang, Qin
一名有急性播散性脑脊髓炎（ADEM）病史的20多岁男子在家中被发现昏倒在地板上没有反应，现场血糖为28 mg/dL，随后被送往急诊室（ED）。在急诊科，患者出现心动过速、呼吸过速和低血压，分别在到达后9小时和12小时需要加压和插管。实验室检查结果为COVID-19阳性，血清钠125 mmol/L，持续低血糖。患者在开始使用降压药前1小时给予高剂量地塞米松治疗COVID-19。随后，患者继续静脉注射应激剂量的氢化可的松，临床迅速改善，拔管，入院第2天停用血管加压药和葡萄糖。患者于第4天下午早些时候接受了最后一剂静脉注射氢化可的松，并计划在第二天早上出院前进行肾上腺测试。第5天，醛固酮<3.0 ng/dL，促肾上腺皮质激素（ACTH）水平>1250 pg/mL，促肾上腺皮质激素刺激试验显示，30和60 min时皮质醇水平分别为3和3µg/dL。抗21-羟化酶抗体阳性。出院时给予氢化可的松和氢化可的松治疗。患者的症状，ACTH升高，低皮质醇和21-羟化酶抗体的存在与自身免疫性Addison病一致。这是首例有ADEM病史的COVID-19患者报告自身免疫性艾迪生病的病例。该病例强调了将肾上腺功能不全作为COVID-19血流动力学不稳定患者的诊断鉴别因素的重要性。
A man in his 20s with a history of acute disseminated encephalomyelitis (ADEM) was brought into the emergency department (ED) after his family found him at home collapsed on the floor unresponsive with a blood glucose of 28 mg/dL at the field. In the ED, the patient was tachycardic, tachypnoeic and hypotensive, requiring pressors and intubation at 9 hours and 12 hours after arrival, respectively. Laboratory results revealed a positive COVID-19 test, serum sodium of 125 mmol/L and persistent hypoglycaemia. The patient was given a high dose of dexamethasone for COVID-19 treatment 1 hour before pressors were started. He was then continued on a stress dose of intravenous hydrocortisone with rapid clinical improvement leading to his extubation, and discontinuation of vasopressors and glucose on day 2 of admission. The patient received his last dose of intravenous hydrocortisone on day 4 in the early afternoon with the plan to order adrenal testing the following morning prior to discharge. On day 5, the aldosterone <3.0 ng/dL, adrenocorticotropic hormone (ACTH) level >1250 pg/mL, and ACTH stimulation test showed cortisol levels of 3 and 3 µg/dL at 30 and 60 min, respectively. The anti-21-hydroxylase antibody was positive. The patient was discharged on hydrocortisone and fludrocortisone. The patient’s symptoms, elevated ACTH, low cortisol and presence of 21-hydroxylase antibodies are consistent with autoimmune Addison’s disease. This is the first case reporting autoimmune Addison’s disease in a patient with COVID-19 with a history of ADEM. The case highlights the importance of considering adrenal insufficiency as a diagnostic differential in haemodynamically unstable patients with COVID-19.
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