Abstract
Introduction
We present the report of the first, to our best knowledge, case of COVID-19 in a tetraplegic person.
Case presentation
A 56-year-old male with AIS A C4 tetraplegia developed fever during the night, without any prodrome. His general practitioner suspected a urinary tract infection and prescribed him antibiotic therapy. After 2 days of antibiotic therapy the fever still persisted, so the individual was admitted to the local hospital and treated with broad-spectrum antibiotics. After 2 days he was transferred to our spinal unit. Considering the worsening of the chest X-ray and fever despite 48 h of broad-spectrum antibiotic therapy, we strongly suspected viral pneumonia. SARS-CoV-2 was detected and antiviral therapy with Lopinavir/Ritonavir, associated with hydroxychloroquine, was promptly started. Fever ceased after 2 days of therapy.
Discussion
Blood test and chest X-ray findings in this patient were similar to previously published findings regarding COVID-19. One difference between this case and the known clinical course of COVID-19 is that did not develop cough. Another interesting feature of our case is that, despite tetraplegia, the clinical course was not severe. Persons with COVID-19 remain asymptomatic, these results underscore the need for rehabilitation and SCI professionals to have a high index of suspicion for COVID-19 in their inpatient and outpatient clients. Only inpatient with fever hase being tested for COVID-19. All new patients are submitted to SARS-COV-2 Test. Moreover, routine testing of patients who have to participate in therapy in common gym areas may be warranted.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (TNCEPERE) The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41:145–51.
Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020. https://doi.org/10.1016/j.ijid.2020.03.017.
Fauci AS, Lane HC, Redfield RR. Covid-19—navigating the uncharted. N Engl J Med. 2020. https://doi.org/10.1056/NEJMe200238.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062.
Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020. https://doi.org/10.1148/radiol.2020200490. [E-pub ahead of print].
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506.
Fogarty MJ, Sieck GC. Spinal cord injury and diaphragm neuromotor control. Exp Rev Respir Med. 2020. https://doi.org/10.1080/17476348.2020.1732822. [E-pub ahead of print].
Taylor PN, Tromans AM, Harris KR, Swain ID. Electrical stimulation of abdominal muscles for control of blood pressure and augmentation of cough in a C3/4 level tetraplegic. Spinal Cord. 2002;40:34–36.
Meisel C, Schwab JM, Prass K, Meisel A, Dirnagl U. Central nervous system injury-induced immune deficiency syndrome. Nat Rev Neurosci. 2005;6:775–86.
Campagnolo DI, Dixon D, Schwartz J, Bartlett JA, Keller SE. Altered innate immunity following spinal cord injury. Spinal Cord. 2008;46:477–81.
Held KS, Steward O, Blanc C, Lane TE. Impaired immune responses following spinal cord injury lead to reduced ability to control viral infection. Exp Neurol. 2010;226:242–53.
Cai G, Cui X, Zhu X, Zhou J. A hint on the COVID-19 risk: population disparities in gene expression of three receptors of SARS-CoV. Preprints. 2020;2020020408. https://doi.org/10.20944/preprints202002.0408.v1.
Corley, MJ, Ndhlovu, LC. DNA methylation analysis of the COVID-19 host cell receptor, angiotensin I converting enzyme 2 gene (ACE2) in the respiratory system reveal age and gender differences. Preprints. 2020;2020030295. https://doi.org/10.20944/preprints202003.0295.v1.
Kucharski, AJ, Russell, TW, Diamond, C, Liu, Y, Edmunds, J, Funk, S, et al. Early dynamics of transmission and control of COVID-19: a mathematical modelling study. Lancet Infect Dis. 2020. https://doi.org/10.1016/S1473-3099(20)30144-4. [E-pub ahead of print].
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Righi, G., Del Popolo, G. COVID-19 tsunami: the first case of a spinal cord injury patient in Italy. Spinal Cord Ser Cases 6, 22 (2020). https://doi.org/10.1038/s41394-020-0274-9
Received:
Revised:
Accepted:
Published:
Version of record:
DOI: https://doi.org/10.1038/s41394-020-0274-9
This article is cited by
-
COVID-19 and spinal cord injury: clinical presentation, clinical course, and clinical outcomes of people hospitalised
Spinal Cord Series and Cases (2024)
-
Early insights of the COVID-19 pandemic in the Veterans’ Affairs spinal cord injury and disorders population
Spinal Cord Series and Cases (2022)
-
COVID-19 and spinal cord injury and disease: results of an international survey as the pandemic progresses
Spinal Cord Series and Cases (2021)
-
Clinical features and prognosis of COVID-19/SARS-CoV-2 infections in persons with spinal cord injury: a review of current literature
Spinal Cord Series and Cases (2021)
-
Meropenem
Reactions Weekly (2021)
