Long COVID Syndrome Presenting as Hyperferritenemia Associated Toxic Encephalopathy in a Deferoxamine Compliant Patient of Beta Thalassemia
Sujal Patel
Department of Medicine, Jawaharlal Nehru medical college, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
Dhruv Talwar *
Department of Medicine, Jawaharlal Nehru medical college, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
Sunil Kumar
Department of Medicine, Jawaharlal Nehru medical college, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
Sourya Acharya
Department of Medicine, Jawaharlal Nehru medical college, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
Mansi Patel
Department of Medicine, Jawaharlal Nehru medical college, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
*Author to whom correspondence should be addressed.
Abstract
Ferritin overload is a frequent problem encountered in patients with beta thalassemia amounting to various complications. One of rare but important complication of ferritin overload is ferritin overload induced toxic encephalopathy. Serum ferritin has been recognised as a important marker of inflammation and cytokine storm in COVID19.We present a case of Long COVID syndrome presenting as toxic encephalopathy in a case of beta thalassemia in spite of the patient being compliant to desferroxamine therapy.This report highlights the synergistic effect of Severe Acute Respiratory Syndrome Coronavirus. 2(SARS CoV 2) mediated neuroinflammation through direct viral invasion and the release of inflammatory cytokines including ferritin resulting in toxic encephalopathy in a beta thalassemia major patient who was already prone to develop hyperferritenemia.Ferritin functions as a pro-inflammatory cytokine and it’s level increases in both thalassemia and COVID-19 and the index case presented here had both the conditions predisoposing him to develop toxic encephalopathy even after being compliant to deferoxamine therapy. It is important to recognise and treat this condition in order to prevent mortality and morbidity in patients of beta thalassemia who contract COVID19.
Keywords: Beta-thalassemia, Long COVID, encephalopathy