Vadlamudi NagendraJawaharlal Nehru Medical college, India
Title: Radiological musculoskeletal manifestations of covid-19 in hospital setting of central rural India
COVID – 19 disease is a multisystemic disease caused by SARS-COV2. Acute respiratory distress syndrome is the most common complication leading to mortality. First case was reported in Wuhan, China in December 2019. WHO declared it as pandemic on March 11th 2020. Musculoskeletal system involvement were rarely reported in the literature. In our study I will be presenting and discussing two rare musculoskeletal manifestations of COVID-19, which presented to our rural hospital in central India (Wardha, Maharashtra) during the first wave of COVID-19 in year 2020.
First case was insidious and gradually progressive pain and swelling of right lower limb in a 47-year-old male patient who was treated for COVID-19 three months ago. He underwent MRI imaging ,which revealed extensive inflammation in anterior, lateral and superficial posterior compartment of right thigh. Laboratory tests showed raised WBC, CRP, ESR, LDH and CK. Patient was diagnosed as post COVID-19 myositis. He was started on NSAID and Prednisolone; after a month, his inflammation subsided.
Second case was a 50 year old patient who presented with difficulty in walking due to pain in right hip since 2 weeks. He has past history of COVID-19 six months ago for which he was admitted in hospital and was given medications (prednisolone and remdesivir). He was advised X ray hip which was apparently normal. He was then advised MRI in which showed changes of avascular necrosis of head of right femur (Ficat arlet grade II). The use of prolonged or high dose of Corticosteroids has been postulated as a cause of AVN in a previous healthy individual. COVID-19 invaded the cells through angiotensin converting enzyme-2 (ACE-2) found in bone matrix. This in turn is aggravated by use of Glucocorticoids which cause hyper-coagulable state and vascular endothelial dysfunction causing vascular compromise to femoral head.
Vadlamudi Nagendra is a final year resident in Department of Radio-diagnosis, Jawaharlal Nehru Medical college, DMIHER, Wardha, India. He has completed his MBBS at the age of 24 from KLE University, Karnataka, India. He has keen interest in the field of Medical Research and Interventional Radiology and is about to start his fellowship (FVIR) in the upcoming months. He has previously presented his research papers in various national conferences. He has over 30 publications in various international journals and actively participates as reviewer in various journals. He has immense interest in research and pursuing PhD in the field of Radiology.