Extrapulmonary Manifestations and Complications of Viral Pneumonia

The novel beta-coronavirus SARS-CoV-2, related to severe acute respiratory distress syndrome, is currently pandemic. Most patients have respiratory symptoms such as fever, cold, cough, and shortness of breath. However, different clinical manifestations can be observed, from asymptomatic cases to mild and nonspecific symptoms or severe complications such as acute respiratory distress and death.

Although COVID-19 is most known for causing respiratory pathology, it can also result in several extrapulmonary manifestations that include: thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, dermatologic complications.

Given that ACE2, the entry receptor for the causative COVID-19, is ubiquitously expressed, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thrombo - inflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19.

Here we review the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 with particular attention to:

• Miocarditis, myocardial dysfunction and arrhythmia and acute coronary syndromes
• Neurological manifestation
• Vasculitis
• Thrombotic complications

Our work will therefore be a review of the most frequent extra - pulmonary manifestations of CPOVID19 with reference to rare forms such as cutaneous vasculitis and rare neurological manifestations (opsoclonus - myoclonus).

Dr. Antonino Mazzone
Guest Editor

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