Severe COVID-19 Pneumonia, Opportunistic Candida krusei Infection, and Acute Respiratory Distress Syndrome with Pulmonary Arterial Hypertension Treated with Bosentan: A Case Report.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Killen H Briones-Claudett, Killen H Briones-Zamora, Jaime Galo Benites Solis, Doménica I Huilcapi Borja, Karelys Nicole Arteaga Ocaña, Maria Antonieta Touriz Bonifaz, Pedro Barberan-Torres, Michelle Grunauer
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引用次数: 0

Abstract

BACKGROUND Despite global vaccination efforts, COVID-19 still necessitates effective treatments for severe cases that can quickly escalate to life-threatening complications, such as acute respiratory distress syndrome (ARDS) and secondary pulmonary arterial hypertension (PAH). Here, we present the clinical journey of a 73-year-old Ecuadorian man who developed severe COVID-19 pneumonia complicated by an opportunistic Candida krusei infection and ARDS, subsequently progressing to long-term PAH, managed with bosentan, an endothelin 1 (ET-1) antagonist. CASE REPORT The patient, vaccinated with 2 doses of CoronaVac, experienced severe COVID-19 complications, including ARDS and secondary PAH, further complicated by a C. krusei infection. Despite prompt mechanical ventilation and intensive care, his condition rapidly deteriorated. Clinical evaluation confirmed COVID-19-associated ARDS, secondary PAH, and C. krusei infection through bronchoalveolar lavage. The therapeutic approach combined bosentan (125 mg twice daily) with dual antifungal therapy, leading to significant stabilization and eventual discharge. Post-discharge assessments showed persistent cardiopulmonary dysfunction, consistent with post-COVID-19 syndrome. CONCLUSIONS This case highlights critical COVID-19 complications in a vaccinated patient. While vaccination may provide substantial protection, COVID-19 pneumonia treated with corticosteroids can increase the risk of opportunistic infections like C. krusei, and ARDS can lead to pulmonary fibrosis and PAH. This case underscores the need for research on therapeutic strategies for complex COVID-19 cases and emphasizes comprehensive, personalized care for managing COVID-19 complications and sequelae.

波生坦治疗重症COVID-19肺炎、机会性克鲁氏念珠菌感染、急性呼吸窘迫综合征合并肺动脉高压1例
尽管全球都在努力接种疫苗,但COVID-19仍需要对严重病例进行有效治疗,这些病例可能迅速升级为危及生命的并发症,如急性呼吸窘迫综合征(ARDS)和继发性肺动脉高压(PAH)。在这里,我们介绍了一名73岁的厄瓜多尔男性的临床历程,他发展为严重的COVID-19肺炎并伴有机会性克鲁希假丝酵母菌感染和ARDS,随后发展为长期PAH,使用内皮素1 (ET-1)拮抗剂波生坦治疗。病例报告:该患者接种了2剂冠状病毒疫苗,出现了严重的COVID-19并发症,包括ARDS和继发性PAH,并进一步并发了C. krusei感染。尽管及时进行了机械通气和重症监护,他的病情仍迅速恶化。临床评价通过支气管肺泡灌洗确认covid -19相关ARDS、继发性PAH和克鲁塞锥虫感染。治疗方法结合波生坦(125mg,每日两次)和双重抗真菌治疗,导致显著稳定和最终出院。出院后评估显示持续心肺功能障碍,与covid -19后综合征一致。结论:本病例突出了接种疫苗患者的COVID-19严重并发症。虽然疫苗接种可能提供实质性保护,但用皮质类固醇治疗的COVID-19肺炎可能会增加克鲁西梭菌等机会性感染的风险,而ARDS可导致肺纤维化和多环芳烃。该病例凸显了研究COVID-19复杂病例治疗策略的必要性,并强调了对COVID-19并发症和后遗症进行全面、个性化护理的必要性。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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