Initially, she was treated with meclizine, antiemetics, and Cawthorne vestibular rehabilitation exercises. Dix-Hallpike maneuver was performed, and she was confirmed with vertigo and diagnosed with post-viral vestibular neuritis. She immediately took medical attention and the physical examination showed a strong nystagmus to the right. She did not have tinnitus or hearing loss. She woke up in the middle of the night with dizziness, a sense of the room spinning and an unsteady gait. One week after she tested negative for COVID-19, she suddenly developed chills and vomitings. Subsequently, she was tested for COVID-19 every week until she was negative on the 58th day. Over the next four weeks, she slowly had some clinical improvement. She also noticed purple discoloration at the base and whitish discoloration at her fingertips with temperature changes, as shown in Figure 1. She continued conservative management with ample hydration, antipyretics, and over-the-counter aspirin, multivitamins, and calcium supplements. There was no associated itching, bleeding, blistering, or discharge. A clinical diagnosis of herpes labialis caused by herpes simplex type-1 (HSV-1) was made.
Lip quiver meaning skin#
There were eight to 10 painful, red skin lesions around 3 mm in size in the lower face, especially around the mouth. Twitching was involuntary, initially started near the left eye, and progressed to the left side of the face. It was not associated with pain, loss of sensations, or numbness. When there were no signs of improvement after a few days of symptomatic management, the nasal polymerase chain reaction (PCR) for the SARS-CoV-2 test was performed in an ambulatory setting, which turned out to be positive, confirming the diagnosis of COVID-19, and she was advised home quarantine.Ībout four weeks after the initial episode, the patient developed twitching of the left eye and left cheek, diarrhea, generalized weakness, palpitations, sleep disturbances, decreased appetite, skin rash, anosmia, and dysgeusia. The symptoms developed in March 2020 when there were no reported COVID-19 cases. She is a resident of the United States but an avid traveler and was in Europe when the symptoms developed. Given the past history of aplastic anemia, she took over-the-counter iron pills for shortness of breath with no improvement. She did not report fever, chills, cough, or chest pain. Case PresentationĪ 63-year-old Caucasian female with a past medical history of aplastic anemia, mitral valve prolapse with regurgitation, celiac disease, and motion sickness presented with a runny nose and breathlessness. We report a 63-year-old Caucasian female who had a diagnosis of COVID-19 with other associated manifestations during her visit to a small country in Europe. Various cutaneous manifestations like a morbilliform rash, urticaria, vesicular eruptions, acral lesions, petechiae, chilblains, livedo racemosa, and distal necrosis are also seen. Guillain-Barre syndrome and inflammation of the brain, spinal cord, meninges, cranial nerve, and peripheral nerve involvement are reported. Olfactory and gustatory involvement resulting in anosmia and dysgeusia are common neurological symptoms in mild cases.
But, later, various neurological manifestations were noticed. Initially, fever, cough, shortness of breath, and myalgia were reported as common symptoms and pneumonia-like features in chest computerized tomography (CT) scan in patients affected by COVID-19. Severe acute respiratory syndrome CoV (SARS-CoV) and novel CoV were believed to share the same receptor, angiotensin-converting enzyme (ACE), hence the virus was termed SARS-CoV-2, and World Health Organization named the disease as coronavirus disease 2019 (COVID-19) in February 2020 and declared it as a pandemic on Ma. As of September 21, 2020, nearly 31.1 million cases and 962,000 deaths were reported in 213 countries and territories. The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, a city in Hubei province in China in December 2019.
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