Features of the new coronavirus COVID-19 infection in identical twins

Abstract

The problem of the clinical course and principles of treatment for the new coronavirus infection COVID-19 remains the most debated issue. At the same time, reliable prognostic criteria that determine characteristics of the disease course and outcome have not been established. Taking it into consideration, we present clinical cases of COVID-19 in identical twins. Patients A. and S., 39 years old, were admitted to the Regional Clinical Infectious Diseases Hospital. The patients were clinically diagnosed with COVID-19 coronavirus infection, verified, moderate form; bilateral polysegmental pneumonia of moderate severity, 1st degree respiratory failure. The course of COVID-19 coronavirus infection in identical twins markedly differed. Patient A. had peripheral blood lymphocytosis, slightly increased ESR, CRP, ferritin, IL-6, and D-dimer level. A paired twin brother (patient S.) had lymphopenia, ESR accelerated up to 20 mm/h, CRP pronouncedly increased up to 10 mg/ml, IL-6 up to 9,5 pg/ml, and D-dimer up to 750 ng/ml. Condition of the patient A. remained stable, on day 13th of treatment, the patient was discharged from the hospital. The condition of the patient S. on day 3rd of hospitalization deteriorated sharply. Considering the decrease in SpO2 level down to 88%, the damage of the lung parenchyma was more than 70%, resulting in the use of antibacterial drugs, anti-IL-6 monoclonal antibodies as well as selective reversible inhibitor of Janus-kinases 1 and 2. On day 16th of treatment, subjectively, the patient showed an improvement in general condition. During the next two days, the patients condition revealed marked positive dynamics on day 19th of hospital stay, the patient was discharged for rehabilitation. Thus, significant differences in the severity of the course of the new coronavirus infection in identical twins with similar medical history and lack of confounding comorbidities are most likely due to the initial dose of the viral load which was an important factor determining the development and course of infection.

Keywords

• covid-19
• identical twins
• clinical case
• course features
• covid-19 treatment
• monoclonal antibodies