June 2020

Extrapulmonary manifestations of COVID-19

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While the respiratory pathology of COVID-19 has taken center stage over the last 6 months, data is beginning to accrue related to its extrapulmonary manifestations, and they are many and widely variable. Conditions that have been associated include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Studies have shown that SARS-CoV-2 has a higher affinity of binding to the ACE2 receptor than SARS-CoV (responsible for SARS epidemic of 2003), which may explain the increased transmissibility. Because ACE2 is expressed in multiple extrapulmonary tissues, several mechanisms may play a role in the multi-organ injury that is secondary to SARS-CoV-2 infection including direct viral toxicity, endothelial cell damage and thromboinflammation, dysregulation of the immune response, and dysregulation of the renin-angiotensin-aldosterone system. Many of these may also occur secondary to sepsis.

To help clinicians and researchers recognize and monitor the organ-specific pathologies, presentations, and clinical management considerations for patients with COVID-19, a group of more than 25 experts published a review in Nature Medicine that is available Open Access at this link: https://rdcu.be/b5xev.

Source: Gupta A, Madhavan MV, Sehgal K, et al. Extrapulmonary manifestations of COVID-19. Nat Med (2020). https://doi.org/10.1038/s41591-020-0968-3

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