COVID-19 tsunami: the ﬁrst case of a spinal cord injury patient in Italy

Spinal Cord Series and Cases, 2020 · DOI: 10.1038/s41394-020-0274-9 · Published: March 30, 2020

Spinal Cord Injury COVID-19 Research Methodology & Design

Simple Explanation

This is a case report about a 56-year-old male with tetraplegia who contracted COVID-19. He initially presented with a fever and was suspected of having a urinary tract infection. Despite his tetraplegia, the patient's COVID-19 case was not severe, which contrasts with expectations given his comorbidity and the known SCI-induced immune depression syndrome. The case highlights the importance of a high index of suspicion for COVID-19 in individuals with spinal cord injuries, even in the absence of typical symptoms like cough.

Study Duration

Not specified

Participants

A 56-year-old male with AIS A C4 tetraplegia

Evidence Level

Level 4: Case Report

Key Findings

1
The patient did not develop a cough, which is a common symptom of COVID-19, likely due to the paralysis of expiratory muscles associated with tetraplegia.
2
Despite tetraplegia, the clinical course of COVID-19 was not severe, with complete healing in a little more than 2 weeks and no need for mechanical ventilation.
3
Blood test and chest X-ray findings in this patient were similar to previously published findings regarding COVID-19.

Research Summary

This case report details the first known instance of COVID-19 in a tetraplegic patient in Italy. The patient, a 56-year-old male with C4 tetraplegia, presented with fever and was initially treated for a suspected urinary tract infection. Despite the patient's underlying condition, the COVID-19 infection was not severe, and he recovered without needing mechanical ventilation. This contrasts with typical expectations for individuals with spinal cord injuries. The report emphasizes the need for heightened awareness and suspicion of COVID-19 in SCI patients, even if they lack typical symptoms like cough, and highlights the importance of preventive measures in spinal units.

Practical Implications

Diagnostic vigilance

Maintain a high index of suspicion for COVID-19 in SCI patients with fever, regardless of the presence of typical symptoms.

Preventive Measures

Implement strict preventive measures in spinal units to protect inpatients from COVID-19 infection.

Caregiver Education

Educate caregivers of SCI patients about the importance of social restriction and early detection of COVID-19 symptoms.

Study Limitations

1
Single case report, limiting generalizability.
2
The mild-to-moderate clinical picture could be attributed to the patient's relatively young age and absence of other comorbidities.
3
Postulated different susceptibility to SARS-CoV-2 based on genetic and epigenetic factors and the actual viral load that he received upon infection.

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