After Covid, a severe headache and blurred vision in the right eye. An infection after the virus infection that led to temporary blindness. The case, rare but certified, was recently published in the American scientific journal Jama (Journal of the American Medical Association).
At the center of the story is a 70-year-old, who suffered acute vision loss from bacterial and IgG4-related rhinosinusitis after being struck by Covid-19. A case that Professor Fausto Baldanti, head of the molecular virology laboratory of the San Matteo hospital in Pavia, defines “more unique than rare”. Specifying: “We consider that Covid is capable of generating thrombosis, therefore infections can occur in all organs, even if for some, such as the kidney, it is more frequent”.
An ozone gel to protect the eyes from Covid
Weakened immune system
Returning to the 70-year-old patient in question, it must immediately be said that he presented an autoimmune disease, precisely IgG4, a fibroinflammatory disease related to mmunoglobulin G4 (IgG4-RD), which can affect almost all organs, with ENT problems such as Mikulicz’s disease and Küttner’s tumor, recently recognized as manifestations of IgG4-RD. For him, in essence, an obstacle at the start, able to complicate things to the point of making them no way out.
The 70-year-old, who before that moment had not had chronic or allergic rhinosinusitis, went to the emergency room with a headache that had been dragging on for two weeks, while for two days he had lost sight in his right eye.
Covid diagnosis
Doctors tried to understand. Investigations led them to link the latest events to what happened to the 70-year-old three weeks earlier, when he experienced the typical symptoms of a cold: runny nose, fatigue. On that occasion he was diagnosed with Covid-19. The appropriate treatment was followed, and the man, from the infection caused by the virus, had recovered. But this was not enough to bring him back to normal, because soon after the headache on his right side got worse and he lost sight in his right eye. When the old man arrived in the emergency room he could no longer see us. It was a maxillofacial CT scan that diagnosed diffuse inflammation. In particular, an erosion of the bone of the medial orbital apex.
Inflammation and surgery
Surgery was inevitable. But, although it guaranteed an initial improvement, the headache and vision of the patient treated with antibiotics progressively worsened. Histopathological analysis later revealed a dense infiltrate of IgG-containing plasma cells, most of which were positive for IgG4. Only the addition of prednisone (a synthetic corticosteroid used in the treatment of many different ailments) to the drugs already prescribed has solved the problem. There was a noticeable improvement in headache and vision, and the man was discharged. Checkups three weeks later revealed that her vision had returned to normal and her headache had completely resolved.
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by Irma D’Aria
First case of Covid blindness
This, according to the authors of the publication “is the first case describing a simultaneous acute and IgG4-related bacterial rhinosinusitis after a previous SARS-CoV-2 infection”. “Although rare – they explain – the rheumatological workup for IgG4-RD in patients with severe rhinosinusitis and acute vision loss is fundamental because the treatment of IgG4-RD differs from that of bacterial rhinosinusitis”. And they add: “Overall, Covid may have led to the exacerbation of the underlying IgG4-RD or an IgG4 response, with the simultaneous precipitation of acute bacterial rhinosinusitis. Although corticosteroids are standard for IgG4-RD and antibiotics for rhinosinusitis. bacterial, simultaneous use of both was effective in this patient who had both diseases. Therefore, corticosteroids and antibiotics may be indicated in patients with severe rhinosinusitis until IgG4-related or bacterial rhinosinusitis can be ruled out. ” .
The danger of thrombosis
An episode that Baldanti defines as “very rare thing”. “This case report tells us, in essence, that the patient was unlucky to contract a bacterial infection in the right eye following a general syndrome, among other things in the presence of an autoimmune disease – comments the professor -. ‘bacterial infection that overlaps with a Covid hospitalization is a more unique than rare complication “. And he adds: “Covid alone is capable of causing thrombosis that can affect all organs. This is the greatest damage that the virus causes. And when we talk about Long Covid we are referring precisely to the sum of the damage that the virus generates. in some patients with other pathologies. But, I repeat, everything starts from the thrombotic effect that the virus gives: some organs infect them directly, such as the lung in which it causes fibrosis (scarring caused by microthrombosis that causes respiratory problems), or the heart. However, in general, for the other organs the consequences derive precisely from thrombosis that cause aftermath at a distance. Even after several months “.
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