A Rare Presentation of Covid-19: Case Series with Conjunctivitis and Ocular Involvement

Öz

Covid-19 infection, which appeared first in the Wuhan region of China in 2019 and identified as the new type of coronavirus, has spread rapidly to different countries and was declared as a pandemia by the World Health Organization. It is thought that viral Covid-19 infection, which has respiratory symptoms such as fever, cough, and shortness of breath, may also have an ocular presentation. 

It was noteworthy that patients who presented to our emergency department with conjunctivitis symptoms during the pandemic also had Covid-19 history or symptoms. In this case series, 7 patients diagnosed with Covid-19 related acute viral conjunctivitis were reported. In accordance with the Covid-19 management guide algorithm of the Turkish Ministry of Health, the Covid-19 diagnosis of patients was confirmed with Real-time polymerase chain reaction (PCR) method and thorax computed tomography. All patients were evaluated as Covid-19 related acute viral conjunctivitis and, hydroxychloroquine and topical ocular antibiotherapy treatment was given. The follow-up of 7 patients who achieved clinical improvement and whose control PCR results were negative was completed.

It should be kept in mind that Covid-19 may be present in patients presenting with conjunctivitis until it is understood whether there is ocular involvement due to Covid-19 in order to prevent transmission and provide accurate diagnosis and treatment, especially during the pandemia.

Anahtar Kelimeler

• Covid-19
• conjunctivitis
• viral conjunctivitis

COVİD-19’ UN NADİR PREZENTASYONU: KONJONKTİVİT VE OKÜLER TUTULUM İLE GİDEN VAKA SERİSİ

Öz

2019 yılında Çin’in Wuhan bölgesinde ortaya çıkan ve yeni tip koronavirus olarak tanımlanan Covid-19 enfeksiyonu, hızla farklı ülkelere yayılmış ve Dünya Sağlık Örgütü tarafından pandemi ilan edilmiştir. Ateş, öksürük, nefes darlığı gibi solunumsal semptomlar gösteren viral Covid-19 enfeksiyonunun oküler prezentasyonu olabileceği akla gelmektedir. Pandemi boyunca acil servisimize konjonktivit semptomları ile başvuran hastalarda Covid-19 hikayesi veya semptomlarının olması dikkatimizi çekmiştir. 

Bu olgu serisinde Covid-19 ilişkili akut viral konjonktivit olarak değerlendirilen 7 hasta bildirilmiştir. TC. Sağlık Bakanlığı’nın Covid-19 yönetim rehberine uygun olarak Real-time polymerase chain reaction (PCR) yöntemi ve toraks bilgisayarlı tomografisi ile tanısı doğrulanan hastalar Covid-19 ilişkili akut viral konjonktivit olarak değerlendirilmiş olup, hidroksiklorokin ve oküler antibiyoterapi tedavisi verilmiştir. Klinik olarak iyileşme sağlayan ve kontrol PCR sonucu negatif olan 7 hastanın takibi tamamlanmıştır.

Özellikle pandemi döneminde bulaşın önlenmesi, doğru tanı ve tedavinin sağlanması adına Covid-19’un oküler tutulumu olup olmadığı anlaşılana kadar, konjonktivit ile başvuran hastalarda Covid-19 enfeksiyonu olabileceği akılda bulundurulmalıdır.

Anahtar Kelimeler

• Covid-19
• konjonktivit
• viral konjonktivit

Kaynakça

1. 1. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine 2020;382(18):1708-20.
2. 2. Lu R, Zhao X, Li J, Niu P, Yang, Wu H et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-74.
3. 3. Loffredo L, Pacella F, Pacella E, Tiscione G, Oliva A, Violi, F. Conjunctivitis and COVID‐19: a meta‐analysis. Journal of Medical Virology. 2020;92(9):1413-4.
4. 4. Bjnews. Erişim tarihi: 1 Eylül 2020: http://www.bjnews.com.cn/news/2020/01/23/678189.html.
5. 5. Lu C, Liu X, & Jia Z. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet (London, England). 2020;395(10224):e39.
6. 6. Seah I, Agrawal R. Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals. Ocular Immunology and Inflammation. 2020;28(3):391-95.
7. 7. Türkiye Cumhuriyeti Sağlık Bakanlığı Covid-19 Drurum Raporu. Erişim tarihi: 1 Eylül 2020: https://covid19bilgi.saglik.gov.tr/tr/covid-19-rehberi.html.
8. 8. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmology. 2020;138(5):575-8.

9. 9. Cheema M, Aghazadeh H, Nazarali S, Ting A, Hodges J, McFarlane A et al. Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19): A case report. Canadian Journal of Ophthalmology. 2020;55(4):125-129.
10. 10. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS‐CoV‐2 infection. Journal of Medical Virology. 2020; 92(6):589-94.