Acute hyperhidrosis and postural tachycardia in a COVID-19 patient
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LETTER TO THE EDITOR
Acute hyperhidrosis and postural tachycardia in a COVID‑19 patient Thirugnanam Umapathi1 · Mervyn Q. W. Poh1 · Bingwen Eugene Fan2,3,4 · Ki Fung Cliff Li5 · Julie George6 · Jackie Y. L. Tan6 Received: 21 July 2020 / Accepted: 15 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Keywords Orthostatic tachycardia · COVID-19 · Dysautonomia Dear Editor, We describe a COVID-19 patient with acute hyperhidrosis and symptomatic orthostatic tachycardia. We encountered 3 other patients with ophthalmic dysautonomia. We posit COVID-19 as a cause of acute, limited, possibly dysimmune, autonomic dysfunction. A 39-year-old man, a construction worker with no medical history, was diagnosed with COVID-19 from nasopharyngeal swab reverse transcription polymerase chain reaction (rt-PCR) when he presented with 8 days of acute respiratory symptoms, diarrhea, abdominal discomfort and pneumonia. Within 2 days‚ he required supplemental oxygen and prone-positioning, and was placed on a remdesivir trial. He recovered without ventilatory support. His blood pressure at admission was 165/92 mmHg. In hospital‚ it ranged from 130 to 170/80–110 mmHg. He was started on amlodipine 2.5 mg. His blood glucose ranged from 9 to 13 mmol/L and HbA1c was 8.8%. He was diagnosed with diabetes mellitus (DM) and given insulin and metformin. At day 13 of illness, as he was recuperating in the general ward with stable blood pressure and parameters, he developed right leg ischemia. Computed tomography (CT) aortogram showed a mural thrombus at the suprarenal aorta. * Thirugnanam Umapathi [email protected] 1
National Neuroscience Institute, Singapore, Singapore
2
Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
3
Lee Kong Chian School of Medicine, Singapore, Singapore
4
Yong Loo Lin School of Medicine, Singapore, Singapore
5
Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
6
Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
Aortic tributaries were unobstructed. Infarcts were limited to the spleen and upper pole of the right kidney. The adrenal gland was normal in appearance. There was no thrombosis of the vena cava. He underwent embolectomy and endovascular repair. Duration of ischemia to reperfusion was approximately 26 h. After initial unfractionated heparin, he was given aspirin and warfarin. The raised factor VIII levels, von Willebrand factor antigen, fibrinogen, anti-cardiolipin antibodies and presence of lupus anticoagulant (Table 1) indicated a COVID-19-associated immuno-thrombotic state [1]. He was extubated the day after surgery and sent to the general ward 2 days later. On day 18, he complained of profound, intermittent bouts of sweating on his trunk and thighs. Simultaneously, he developed constipation, nausea and post-meal upper abdominal discomfort. He had marked symptomatic tachycardia (140/min) on standing, without associated orthostatic hypotension. However, he no longer required amlodipine. He had no head
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