Clinical characteristics of severe infections by sars-cov-2 in Colombian patients with covid-19 and rheumatic diseases: A case series study

Objectives: To describe the clinical characteristics and results of a group of patients with confirmed SarsCoV-2 infection and a history of rheumatic disease treated in a high complexity hospital in Bogota, Colombia Methods: Case series that studied the outcomes of 19 adult patients with a confirmed diagnosis of a rheumatological disease from a cohort of 1,450 patients that were attended to in the emergency room (ER) between March and August 2020. The 19 patients had severe illness, and required hospitalization. Approved by the ethics committee. Results: During the study period, (42.4%) of the ER group tested positive for SARS-CoV-2;992(63.6%) were managed on an outpatient basis;528 (36.4%) required inpatient management. The average age of the outpatient group was 38.9 years. 64.7% were male. All 19 who had a history of rheumatic or musculoskeletal disease, had COVID-19 infection, corresponding to 1.3% of all patients positive. The most frequent rheumatic diagnosis was rheumatoid. Arthritis (42.1%), gouty arthritis (15.7%), Sjogren's syndrome (15.7%), psoriasis (10.5%) and systemic lupus erythematosus(10.5%). The most frequent comorbidities were hypertension (63.1%), hypothyroidism(15.7%), diabetes (10.5%), and chronic renal disease (9.1%). The predominant COVID-19 symptoms were coughing (94.7%), fever (68.4%), general discomfort (63.1%), odynophagia (47.3%), dyspnea (52.6%), headache (10.5%), and diarrhea (12.5%). Furthermore, 11/19 patients (57.8%) presented severe COVID-19 symptoms, which required hospitalization, with the average age of 63.91 years;the patients were older than those with amild infection (51.2 years old). The hospitalized patients were alsomore likely to have arterial hypertension (90.9%) and diabetes(18.2% %) cough(100%), fever (81.8%), and odynophagia(63.6%). 36.4% showed lymphopenia. All had hypoxemia at the time of admission, and 36.4% were found to have pneumonia changes on X-ray films. Only three patients received antibiotic treatment, and all immunosuppressants except corticosteroids were suspended during hospitalization. Of the 11 hospitalized patients, two were admitted to intensive careone of whom received invasive mechanical ventilation. Conclusion: This case series analyzed 19 patients in a hospital in Bogota with a rheumatic disease and COVID-19 infection. It showed that about two thirds required hospitalization, were over 60 years of age, half were male with comorbidities, and treated with systemic steroids, and were more likely to experience severe manifestations of a COVID-19.