Discussion
We report a case of a 16-year-old female with established systemic lupus erythematosus (SLE) diagnosis for 5 months and is currently on steroids presenting with hypocalcemia and pulmonary embolism diagnosed clinically in the setting of COVID19 infection.
In terms of infections, SLE increases the risk of infections, both common and opportunistic, with the lung being the most affected organ. It does so through impairing both arms of the immune system, the cellular and humoral immunity (5). COVID-19 is not an exception. Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a coronavirus that spreads mainly through respiratory droplets (6). COVID19 infections, on the other hand, are also thought to increase the risk of autoimmune diseases through the production of autoantibodies and autoimmunity (7).
With regard to thrombotic phenomenon, both COVID19 infection and SLE have been thought to cause such presentation. Complement activation in COVID19 can cause thrombotic microangiopathy that can mediate organ damage in severe cases, resembling a complement-mediated thrombotic microangiopathy (8,9). Some factors that may be implicated in thrombosis in SLE include immune response through the circulating complexes along with auto-antibodies and the high state of inflammation that ensues during the disease activity (10).
Hypocalcemia with COVID19 infection has been reported many times in the literature along with low lymphocytes and elevated LDH, liver enzymes, CK as well as CRP and is a frequent finding including a case of Italian patient with acute severe hypocalcemia. Mechanisms for such finding include a viral action requiring calcium for pathogenesis, malnutrition as well as abundance of unsaturated fatty acids that present in high levels during this viral infection, therefore, its severity can predict the outcome for patients, hence proper evaluation and management should be done (11).