COVID-19: Damage found in multiple organ systems

By Paul Basilio, MDLinx
Published April 15, 2020

Key Takeaways

By now, the catastrophic pulmonary effects of COVID-19 are well documented. However, physicians are currently seeing more evidence of the damage that the infection can do to other organ systems, such as the heart, kidneys, and liver, to name a few.

While underlying conditions and adverse effects of certain drugs are being investigated, the likely culprit in many patients with extrapulmonary disease is thought to be a “cytokine storm,” in which the patient’s immune system responds overwhelmingly to an infection. The widespread cytokine release can cause cellular, organ, and tissue damage.

Heart inflammation

Cardiac injury due to viral infections is well documented, but SARS-CoV-2 appears to be particularly harmful, according to several studies.

Patients with known underlying heart conditions continue to be at the greatest risk for cardiovascular- and respiratory-related COVID-19 complications, followed by those with previously undiagnosed conditions that are unmasked by the virus. Some patients with asymptomatic fatty plaques inside the heart vessels may find those plaques destabilized by fever and inflammation.

A subset of patients with COVID-19 who had been previously healthy and had no underlying cardiac problems are now developing severe, sudden inflammation of the heart muscles as a result of a direct attack by the virus. This inflammation can cause rhythm disturbances and muscle damage, interfering with the heart’s ability to effectively pump blood throughout the body.

Cytokine storm is thought to be the driver in these patients. Thankfully, these types of reactions are rare relative to the overall COVID-19 patient population. 

Treatment with cytokine inhibitors has shown some promise, but the treatment comes with inherent risks. Cytokine inhibitors, such as interleukin (IL)-6 inhibitors, can suppress the patient’s immune system at a time when it is needed most.

More research is needed on these types of drugs in patients battling active infections.

Neurologic effects

Physicians in China recently discovered COVID-19 can damage the CNS.

A 56-year-old male patient with severe COVID-19 symptoms who was not responding to regular treatment developed decreased consciousness despite normal CT findings. Gene sequencing of a CSF sample showed the presence of SARS-CoV-2.

After receiving treatment for viral encephalitis, the patient’s neurologic symptoms gradually abated.

Meanwhile, in Detroit, a female patient was identified as having the first case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. In addition to cough and fever, the patient had confusion, lethargy, and disorientation. 

Her imaging findings were consistent with cytokine storm syndrome.

Kidney disease

Almost half of all patients with COVID-19 have evidence of blood or protein in the urine, indicating early kidney damage, according to Alan Kliger, MD, a nephrologist at Yale University. In addition, early data has shown that around 15% to 30% of patients with COVID-19 in the ICU in New York and Wuhan, China, have required dialysis or continuous renal replacement therapy.

The situation in New York is so dire that there is a shortage of personnel who can provide treatment, as well as a shortage of machines and sterile fluids.

While experts stress that it is too early to reach definitive conclusions, it does appear that the virus is directly attacking the kidneys.

Liver and gastrointestinal tract

COVID-19 is reportedly causing diarrhea, vomiting, and other gastrointestinal (GI) symptoms in approximately half of all patients. Patients with GI symptoms may also develop a cough and vice-versa, but one symptom typically appears days before the other.

Acute viral hepatitis has also been found in some patients battling COVID-19. 

For example, researchers documented the case of one 59-year-old woman in Long Island, NY, who presented with dark urine that was later diagnosed as acute viral hepatitis. After developing a cough, physicians connected it with COVID-19. Reports out of China have also tied COVID-19 with liver damage.

Venous thromboembolism

In Wuhan, physicians are reporting abnormal blood coagulation in patients with COVID-19.

In a recent study, 20 of 81 patients with COVID-19–related pneumonia also had venous thromboembolism (VTE). Of those patients, eight died. The authors stated that a significantly increased D-dimer level showed promise for identifying patients at high risk for VTE. 

While the extrapulmonary effects of COVID-19 do appear to be rare, physicians and researchers are beginning to identify the myriad of ways the infection can damage the body. Research into mechanisms of infection and possible treatments is ongoing. 

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