Development of the Waterhouse-Friderichsen syndrome after infection with SARS-CoV-2 in a patient with rheumatoid arthritis and secondary AA-adrenal amyloidosis

Abstract

The COVID-19 pandemic has also affected rheumatic diseases. A clinical case of the development of the Waterhouse-Friderichsen syndrome after SARS-CoV-2 infection in a patient with secondary AA - adrenal amyloidosis is presented. Description of the case. Patient G.G., 57 years old, was hospitalized for several hours on May 20, 2023 at the Cheboksary Regional Hospital with a diagnosis of severe viral interstitial pneumonia. Secondary AA adrenal amyloidosis. Acute adrenal insufficiency. She was admitted with complaints of an increase in body temperature up to 38.20C. Computed tomography of the chest organs showed signs of bilateral viral interstitial pneumonia (the percentage of lung damage was 74%). The diagnosis of COVID-19 was based on a positive PCR test in nasopharyngeal swabs. Blood pressure - 80 / 40 mm Hg. Art. D - dimer - 786 ng / ml (not higher - 243 ng / ml). Despite treatment, the patient died. At autopsy in the lungs, dystelectasis, hyaline membranes, intraalveolar edema. In the adrenal glands - the deposition of amyloid masses, foci of necrosis of the cortical layer and hemorrhage. Signs of DIC - syndrome. Conclusion. The peculiarity of the case is the development of the Waterhouse-Frideriksen syndrome without signs of sepsis.