iarjaccIARJACCIARJACC2709-188010.47310/iarjacc,2022.03,02.71Institutionalised Mitochondrial Disorders are at Risk of Dying from Unrecognised SARS-CoV-2 InfectionJosefFinstererMD, PhD, Neurology & Neurophysiology Center, Vienna, Austria,A limitation of the study is that a SARS-CoV-2 infection was not ruled out as the cause of gastro-enteritis leading to the initial admission. Because the events apparently took place after the start of the SARS-CoV-2 pandemic, it cannot be ruled out that the patient deteriorated because of an undiagnosed COVID-19 infection. Arguments for a SARS-CoV-2 infection are that the patient was institutionalised and manifested with gastro-enteritis. Institutionalised patients are at an increased risk of contracting and dying from a SARS-CoV-2 infection.[2] It is also known that SARS-CoV-2 infections can manifest itself not only in the lungs but also in extra-pulmonary sites, including the gastro-intestinal tract.[3] In patients with manifestations of COVID-19 with extra-pulmonary onset, the causative agent can be difficult to confirm. We should be told whether the patient was SARS-CoV-2 vaccinated at the time of the first deterioration.