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Intellectus

Intellectus

Synopsis

This case report describes the presentation and treatment of severe hypothermia in a 41-year-old female COVID-19 patient who had previously received two doses of the Moderna vaccine. The patient had multiple comorbidities and was encephalopathic upon presentation with hypothermia of 27.2 °C and bradycardia of 35 beats per minute. Despite undergoing active rewarming with established therapeutic measures, the patient clinically declined and ultimately expired. This case is significant as it documents a previously unreported manifestation of COVID-19 disease in a vaccinated patient and emphasizes the potential for severe outcomes, even in those who have received two doses of the Moderna vaccine. This report emphasizes the need for clinicians to be aware of the possibility of hypothermia in COVID-19 patients and consider it as a potential complication, even in those who have been vaccinated.

Abstract

Hypothermia is an uncommon presentation of COVID-19 infection, typically observed in patients with severe disease prior to the availability of vaccines. However, the occurrence of hypothermia in vaccinated patients with COVID-19 disease has not yet been documented. This case reports a rare presentation of severe hypothermia in a 41-year-old female with COVID-19 disease, who suffered from several comorbidities, including heart failure with preserved ejection fraction, chronic pericardial effusion, nephrotic syndrome, CKD 4, hypertension, type 2 diabetes, thyroid cancer status post-thyroidectomy with resultant postsurgical hypothyroidism, glaucoma, and anemia of chronic disease. Upon presentation, the patient was encephalopathic with hypothermia of 27.2 °C (81 °F) per rectal thermometer and bradycardia of 35 beats per minute. The patient underwent active rewarming, which included warm fluids, heated high flow nasal cannula 5L/min FiO2 28%, and Bair hugger with the goal of rewarming the patient at no greater than 2°C per hour. The patient recovered her temperature overnight, but remained encephalopathic. Despite adherence to the established therapeutic measures for severe hypothermia, the patient clinically declined and expired. This case underscores the potential for hypothermia to manifest in patients with COVID-19 who have received two vaccine doses. The implications of this finding will be discussed, highlighting the need for further research and awareness regarding hypothermia as a possible presentation of COVID-19 in vaccinated individuals.

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