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We present a case of a 65-year-old woman with a persistently positive nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 PCR who developed new complications of coronavirus disease 2019 (COVID-19) 63 days from illness onset. She presented with intermittent fevers, fluctuating disorientation, gait instability, diffuse corticospinal tract signs, and acute venous thromboembolism. No alternate diagnosis was identified. This case highlights the potential for prolonged SARS-CoV-2 PCR positivity and persistent multisystem complications (particularly neurological), even after several months of initial COVID-19 diagnosis.

Background Identifying factors that can predict severe disease in patients needing hospitalization for COVID-19 is crucial for early recognition of patients at greatest risk. Objective (1) Identify factors predicting intensive care unit (ICU) transfer and (2) develop a simple calculator for clinicians managing patients hospitalized with COVID-19. Methods A total of 2,685 patients with laboratory-confirmed COVID-19 admitted to a large metropolitan health system in Georgia, USA between March and July 2020 were included in the study. Seventy-five percent of patients were included in the training dataset (admitted March 1 to July 10). Through multivariable logistic regression, we developed a prediction model (probability score) for ICU transfer. Then, we validated the model by estimating its performance accuracy (area under the curve [AUC]) using data from the remaining 25% of patients (admitted July 11 to July 31). Results We included 2,014 and 671 patients in the training and validation datasets, respectively. Diabetes mellitus, coronary artery disease, chronic kidney disease, serum C-reactive protein, and serum lactate dehydrogenase were identified as significant risk factors for ICU transfer, and a prediction model was developed. The AUC was 0.752 for the training dataset and 0.769 for the validation dataset. We developed a free, web-based calculator to facilitate use of the prediction model (https://icucovid19.shinyapps.io/ICUCOVID19/). Conclusion Our validated, simple, and accessible prediction model and web-based calculator for ICU transfer may be useful in assisting healthcare providers in identifying hospitalized patients with COVID-19 who are at high risk for clinical deterioration. Triage of such patients for early aggressive treatment can impact clinical outcomes for this potentially deadly disease.

Brain stem encephalitis is an unusual form of CNS listeriosis that is associated with a high mortality. This is a case of a 46 year-old male with a history of dermatomyositis on methotrexate who presented with fever, headache, assymetrical cranial nerve palsy and right hemiparesis. MRI showed a ring-enhancing lesions in medulla oblongata. CSF cultures grew Listeria monocytogenes. Despite treatment with ampicillin and gentamicin, the patient developed three rare manifestations of neurolisteriosis namely rhombencephalitis, hydrocephalus and brainstem hemorrhage and did not survive. Early detection and treatment is vital in preventing adverse outcomes.

Highlights • Cerebral paragonimiasis is rare and usually seen in young patients. • Infection is acquired by ingesting infected raw shell-fish. • Serology is highly specific and sensitive for diagnosis of paragonimiasis. • CNS paragonimiasis is treatable and has a favorable prognosis., Cerebral paragonimiasis is rare and is usually seen in younger patients. This is a case of a 19-year-old male presenting as a hemorrhagic stroke with headache and blurred vision. He was found to have cystic thick-walled spaces with focal linear tracking towards the pleural space on computed tomography of the chest. CSF analysis showed pleocytosis with 4% eosinophils. Serological testing confirmed the diagnosis of paragonimiasis. He was treated with praziquantel, corticosteroid taper and anti-epileptic medication and discharged home in stable condition. CNS paragonimiasis is treatable, has a fairly good prognosis but can often be missed. In a young person presenting with an acute hemorrhagic stroke, the possibility of paragonimiasis should be kept on the differential diagnosis.