Long COVID and Multi Organ System Dysfunction

Introduction: We are in the infancy of data collection on the long term effects of the COVID virus on surviving patients. The spectrum and duration of symptoms, patient treatment, etc. are all unknown. This case contributes to the growing body of data of a Long COVID patient with multi-organ system involvement. The case may provide insight into the complex nature of this disease informing treatment options.

Case Study: 35yo male diagnosed in Oct 2022 with COVID-19. Acute symptoms resolved, followed by development of shortness of breath, food sensitivities, diarrhea, cognitive dysfunction, peripheral neuropathy, migraines, abdominal pain, and fatigue. Pulmonary function testing showed mixed restrictive and obstructive disease. He was diagnosed with severe persistent asthma. Gastroenterology performed a colonoscopy, diagnosis of irritable bowel syndrome was subsequently made. Neurology evaluated him for peripheral neuropathy and cognitive impairments and he was started on amitriptyline and pregabalin. Neurology referred him to a neuro-psychiatrist for cognitive testing, which showed severe impairment. Due to lack of control of pulmonary and gastro symptoms, the patient was seen by an allergist who performed allergy testing showing severe allergic reactions to most allergens tested; notably previous testing had been negative. Patient is currently being medically separated from the military due to the debilitating nature of his symptoms.

Discussion: Long COVID, also known as post-acute sequelae of COVID-19, affects 10-30% of infected. The CDC defines it as the cumulation of new/returning/or ongoing symptoms from acute COVID-19 that endure past 28 days. An infected individual’s course can be conceptualized into three phases. Phase 1- the acute phase, lasting days to weeks. Phase 2- multi-system inflammatory syndrome, occurring two to five weeks after onset. Phase 3- Long COVID. The spectrum of symptoms with Long COVID is broad: abdominal pain, chest pain, anosmia, cognitive impairment, dizziness, dyspnea, fatigue, headache, insomnia, mood changes, palpitations, paresthesia, post-exertional malaise, etc. These symptoms can fluctuate, persist, relapse, and remit. Surveys have shown 85.9% of patients with Long COVID past six months will experience a relapse.
The first line for these patients accessing care is the primary care clinic. High suspicion and early management of treatment paradigms can increase patients’ quality of life significantly, which is drastically decreased in this population. Treatment paradigms gear towards supportive care, expectation management, and optimization of underlying medical conditions. Treatment recommendations are based on expert opinion and consensus guidelines due to absence of completed clinical trials. The ultimate prognosis for these patients is yet unclear.