Peculiarities of long-COVID-19 and treatment strategy: a clinical case

Introduction. Over the past two years, the world has faced a serious problem – the emergence of a highly contagious and virulent new type of coronavirus – SARS-CoV-2, which causes acute respiratory disease - COVID-19. Disease with COVID-19 can have medical consequences that last from weeks to months after microbiological recovery. Manifestations and symptoms, as well as laboratory parameters that persist for several weeks after acute COVID-19 disease and do not return to a healthy baseline, can potentially be consider long-term consequences of the disease. Manifestations of "Post-syndrome" are chronic fatigue syndrome (ME/CFS), headache, prolonged low-grade fever, swollen lymph nodes, joint pain, respiratory disorders (dyspnea, shortness of breath), loss of smell and/or taste, hair loss, sweating, nausea. After an acute episode of SARS-CoV-2, some patients develop myalgic encephalomyelitis, a so-called chronic fatigue syndrome that prevents patients from returning to work and lifestyle for months after microbiological recovery. Convalescents may experience long-term side effects resembling the symptoms of chronic fatigue syndrome: persistent fatigue, diffuse myalgia, depressive symptoms and sleep disturbances. The SARS-CoV-2 virus is known to cross the blood-brain barrier to the hypothalamus through the olfactory tract. The probable pathogenesis corresponds to typical signs in patients with CFV / ME, including lymphatic drainage disorders from microglia in the brain. One of the main ways of lymphatic drainage of the brain passes through the perivascular spaces along the olfactory nerves through the lattice bone (os ethmoidale) to the nasal mucosa. Such disorders lead to the accumulation of pro-inflammatory agents, especially post-infectious cytokines such as interferon-gamma and interleukins. These mediators may affect the neurological control of the "glymphatic system". Their accumulation in the central nervous system and can lead to symptoms of chronic fatigue syndrome and other manifestations of Post-COVID syndrome. The pathogenesis of virus-associated arthritis is only partially understood, but one of the mechanisms that should mediate the activation of the inflammatory process is molecular mimicry, which is responsible for inducing autoimmune reactions in predisposed individuals. Clinical case. Patient N. 25 years old without special comorbidities became ill with COVID-19 on September 15, 2020, was ill for 10 days, was treated on an outpatient basis in Medical Center X with a diagnosis of COVID-19 (U07.1), viral pneumonitis combined with bilateral lower lobe pneumonia. Respiratory failure - 0 (PCR test for SARS-CoV-2 positive on the day of treatment). Two weeks after microbiological recovery, the patient returned to the clinic with complaints of headache, impaired concentration, panic attacks associated with shortness of breath, prolonged low-grade fever, enlarged lymph nodes of 5 groups (posterior cervical, cervical, submandibular, supraclavicular, axillary lymph nodes) on palpation in size from 10 mm (posterior cervical, cervical, supraclavicular and inguinal) to 30 mm (submandibular), joint pain of 4 groups (elbow, knee, wrist and fingers). After laboratory and clinical examination, the diagnosis was: secondary immune dysfunction (by cell type), post-COVID syndrome, reactive arthritis (mild). Erbisol drugs were recommended as a therapeutic strategy. After treatment (day 25), the patient felt well, during the laboratory examination all immunological parameters returned to normal, there were no complaints. Recommendations for a healthy lifestyle were given and maintenance vitamin therapy was prescribed for 3 months. Conclusion. All the effects of COVID-19 have not been yet sufficiently identified and studied, but there have been many reports of cases of Post-COVID syndrome. It is necessary to study the mechanisms of development of this condition, but already we need effective therapeutic approaches based on understanding the immunological mechanisms of post-viral inflammation. In such circumstances, it is advisable to use known immunocorrection therapy used in the treatment of such secondary autoimmune disorders and post-infectious immune disorders.