CENTRAL DIABETES INSIPIDUS WITH COVID-19 PNEUMONIA

A CASE REPORT

Abstract

INTRODUCTION
Although COVID-19 is well-known for its respiratory manifestations, extrapulmonary presentations such as cardiac arrythmias, acute coronary syndrome, thrombosis, neurologic and ocular illnesses have also been reported. The mechanism of extrapulmonary complications of COVID-19 involves both the direct effects of SARS-CoV-2 via ACE2 receptors and indirect mechanisms associated with dysregulated host immune response. Apart from the respiratory system, ACE2 receptors are widely expressed in the cardiovascular, gastrointestinal, urogenital and nervous systems, which explains the multisystemic effects seen in COVID-19.

CASE
We present a case of COVID-19 pneumonia complicated by central diabetes insipidus. A 64-year-old female with hypertension, diabetes mellitus and atrial fibrillation presented with fever and vomiting for
two days. She was lethargic, with stable vitals and slight tenderness at the right upper quadrant of abdomen. She was initially treated with antibiotics in the emergency unit for ascending cholangitis. Contrast-enhanced abdominal CT showed cholelithiasis with no intraabdominal collections. COVID-19 GeneXpert tested positive. Chest radiography showed right lower zone opacities. On the ninth day of admission, she had polyuria (6000 mL in 24 hours). Test results showed serum Na 141 mmol/L, serum osmolarity 300 mOsm/kg, urine osmolarity 89 mOsm/kg and urine Na 15 mmol/L, suggestive of diabetes insipidus. She responded well to subcutaneous desmopressin, which reduced urine output to 15 to 30 mL/hour and improved results of her paired samples. While pituitary tests were normal, MRI revealed absence of T1 hyperintensity in the posterior pituitary, supporting the diagnosis of central DI. She required regular desmopressin doses for up to 3 weeks. Her polyuria resolved in her subsequent admission 4 months later for heart failure.

CONCLUSION
This case highlights self-limited diabetes insipidus as one of the extrapulmonary manifestations of COVID-19.