TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS最新文献

{"title":"Covid-19 Pneumonia and Invasive Pulmonary Aspergillosis","authors":"H. Desai, J. Selickman, K. Pendleton","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4083","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4083","url":null,"abstract":"Introduction: Invasive pulmonary aspergillosis (IPA) is a rare, severe fungal infection with a poor prognosis and high mortality rate. IPA is mainly noted in patients with immunosuppressed status, hematological malignancies and stem cell transplants. Diagnosis is challenging and requires a high index of suspicion. Current literature supports treating patients with severe covid-19 pneumonia with high dose dexamethasone therapy for a prolonged period of time which may cause significant immune suppression. Here, we present a case of a patient with covid-19 pneumonia who developed IPA after dexamethasone and tocilizumab therapy. Case report: Patient is a 75-year-old male who was admitted to the medical ICU with severe hypoxemic respiratory failure secondary to covid-19 pneumonia requiring mechanical ventilation immediately on presentation to the emergency room. The patient had a past history of cavitary lung disease secondary to tuberculosis in 2018 and had completed treatment with 4-drug therapy. During this hospitalization, three sputum samples were negative for acid fast bacillus. He was started on dexamethasone therapy of 6mg daily for 10 days and received a single dose of tocilizumab. The patient initially improved but started to worsen again on the ninth day requiring increased ventilatory support and pronation therapy. His sputum culture grew Aspergillus FLavus. CT chest showed increased parenchymal infiltrates around prior cavitary lung disease. Serum aspergillus galactomannan antigen returned positive. Patient was started on intravenous Voriconazole. After initial improvement, the patient developed hemoptysis and worsening oxygenation. As per the family's wishes, patient was transitioned to comfort care and he passed away after compassionate extubation. Discussion:Treatment of COVID-19 pneumonia with high dose dexamethasone therapy may inadvertently cause an immunosuppressed state. These immunosuppressive effects may be further compounded by concurrent use of tocilizumab. Relative immunosuppression combined with possible epithelial damage due to viral infection may be a mechanism for development of IPA. A case series from France reported possible IPA in 9 of 27 (33.3%) ICU patients with COVID-19 with an expectedly high observed mortality rate. Conclusion: Clinicians should carry a high index of suspicion and pursue early investigations for other infections in COVID-19 patients who are not recovering or have worsened after initial improvement. Careful use of steroids in patients with prior structural lung disease is also warranted as they may be at high risk of developing IPA due to pre-existing aspergillus colonization.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90483962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case of Acute Inflammatory Demyelinating Polyneuropathy in SARS COVID 19 Pneumonia","authors":"V. T. Gonuguntla, A. Bernstein, Y. Kupfer","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4073","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4073","url":null,"abstract":"Introduction: Severe acute respiratory syndrome from COVID 19 typically presents with cough, fever, myalgias and progresses to respiratory and multi-organ failure. However, neurological manifestations of COVID 19, namely Guillain-Barre syndrome are rare. We present a case of acute inflammatory demyelinating polyneuropathy (AIDP), a form of GBS in a patient with recent COVID infection. Case: 66 year old man with no significant medical history presented to the emergency department for progressive weakness of all extremities for 2 days. Patient was diagnosed with COVID 19 three weeks prior to onset of weakness. As per patient, he only had mild respiratory illness with cough, general weakness without respiratory symptoms. Two days prior to presentation, he felt weakness in his lower extremities, which then progressed to involve the upper extremities. On initial evaluation the patient's pupils were symmetric and 3mm, reactive to light, visual field were full to confrontation, cranial nerves intact, shoulder shrug symmetric with full strength. He had decreased motor tone with 2/5 strength in both upper and lower extremities and depressed or absent reflexes in all extremities. His labs were significant for positive COVID 19 PCR and antibodies. CT head was negative for acute stroke or intracranial pathology. The patient was admitted to MICU where he developed respiratory muscle weakness with diminished vital capacity of 12ml/kg and negative inspiratory force of 12mmHg and he was intubated. Cerebral spinal fluid showed elevated protein to 145mg/dL, WBC of 4/UL with 50% lymphocytes and glucose of 67. Other CSF studies were negative for oligoclonal bands, EBV, CMV, cryptococcus, syphilis, and sarcoidosis. Electromyography was consistent with moderate AIDP. He received 5 doses of IVIG with no significant improvement so he underwent tracheostomy and was initiated on plasmapheresis for AIDP. Discussion: GBS is an immune-mediated disease that typically affects the peripheral neurons and nerve roots after respiratory or gastrointestinal illness. Typical infections are Campylobacter jejuni, Zika virus, Influenza, and there are even reports of GBS after MERS and SARS COV-1. However, there has been increasing evidence of COVID 19 causing neurologic manifestations such as encephalitis, meningitis, stroke, and GBS [1]. Patients, such as the one presented in this report with GBS, usually have a long and protracted disease despite aggressive treatments with IVIG and plasmapheresis with reliance on mechanical ventilator. Understanding the full spectrum of diseases and systems affected by COVID 19 can help clinicians provide better care.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"124 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87816936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Functional Adrenal Insufficiency Secondary to COVID-19 Infection","authors":"M. A. Ahmed, C. Sun, A. Mohan, D. Djondo","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4086","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4086","url":null,"abstract":"Since the outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic, over seventy million cases have been reported worldwide. Patients present with various symptoms, including extra-pulmonary manifestations. However, manifestations on adrenal glands have not been reported extensively. Here, we present a case of functional adrenal insufficiency in a COVID-19 patient. A 61-year-old male with a history of hyperlipidemia presented with fatigue, cough, and dyspnea, subsequently tested positive for COVID-19. His blood pressure (BP) on admission was 128/68 mmHg with 86% oxygen saturation on room air. Dexamethasone 6mg daily was started for ten days. Remdesivir was contra-indicated, considering the ALT of 246 and AST of 248. On day seven of hospitalization, he had progressively worsening respiratory symptoms and was transferred to the Intensive Care Unit with BP of 105/63 mmHg. Within 48 hours, he showed positive orthostatic vitals with BP of 85/54 mmHg. Despite intravenous hydration, his BP was consistently low on subsequent days with 88/53 mmHg and 99/66 mmHg. His serum total cortisol level was 9.2 μg/dL, and he showed a positive response to IV Hydrocortisone 50mg as well as oral prednisone 10 mg the following day. We did not obtain a cosyntropin stimulation test because of recent corticosteroid therapy. Midodrine 2.5mg three times daily (TID) was started, then increased to 10 mg to maintain BP and alleviate orthostatic symptoms. However, symptomatic positive orthostatic vitals were persistent. He was discharged on midodrine 7.5 mg TID and Fludrocortisone 0.1 mg daily for suspicion of functional adrenal insufficiency. Additionally, a HDL level of 22 mg/dL was recorded (vs 56 mg/dL six months ago). At three months follow-up, he was off fludrocortisone and midodrine with improved orthostatic symptoms. Hypotension and orthostatic symptoms in COVID-19 could be due to IL-1, IL-6, or tumor necrosis factor-mediated reduction in ACTH secretion. Acute illnesses, including COVID-19, may also increase cortisol demand, causing adrenal insufficiency. Decreased HDL noted in our patient could be another etiology. \"Critical Illness-Related Corticosteroid Insufficiency\" (CIRCI) is a functional adrenal insufficiency that is not strictly dependent on cortisol level for diagnosis but mostly on the inadequacy of cortisol for inflammation control or supplying the raised metabolic demand. Decreased cortisol complex cleavage, increased activity of an enzyme responsible for cortisol inactivation, and decreased numbers and affinity of cortisol receptors were postulated to play a role. Therefore, adrenal insufficiency as a cause of hypotension following COVID-19 infection should not be overlooked despite normal cortisol levels.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85686757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: Too Sweet to Handle? A Case of New-Onset Diabetes Mellitus with Severe Diabetic Ketoacidosis Precipitated by Mild COVID-19 Pneumonia","authors":"S. Ricker, E. Bradley, A. Astua","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4107","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4107","url":null,"abstract":"Introduction: As further studies elucidate the extent of organ systems affected by COVID-19, extra-pulmonary involvement is emerging as an important contributor to its morbidity and lethality. Beta-islet cells in the pancreas have been shown to be affected by COVID-19 via ACE2 and TMPRSS2 receptors. Accordingly, diabetes mellitus (DM) has not only been described as an independent risk factor for severe COVID-19, but there is also an association between new-onset DM (NODM) and diabetic ketoacidosis (DKA) with COVID-19. This case report discusses a patient with NODM presenting with DKA precipitated by COVID-19. Case Summary: A 45-year-old male with no past medical history who emigrated from India in March 2020 presented to the emergency department with five days of dyspnea, chills, fatigue, polyuria, and polydipsia. He was COVID-19 PCR-positive while his labs were remarkable for WBC 14, sodium 126, bicarbonate 2, glucose 350, anion gap 33, pH 6.95, pCO2 26, lactate 4.4, D-dimer 479, LDH 350, Ferritin 2381, Procalcitonin 1.13, HIV negative, and significant ketonuria. Chest x-ray revealed bilateral lower lobe patchy infiltrates consistent with COVID-19. He was started on an insulin drip, therapeutic Enoxaparin, and fluid resuscitation. He did not require supplemental oxygen and was not treated with steroids or antivirals. He was transitioned to subcutaneous insulin after one day. He was discharged after an uncomplicated five-day hospital stay. Discussion: There has been an increasing number of reports describing DKA precipitated by COVID-19 in patients with NODM, though our patient presentation is unique because he had a mild COVID-19 course that precipitated severe DKA. This case indicates a more direct role of COVID-19 damaging beta-cells in the pancreas as our patient remained on insulin and no other diabetic medications at discharge and after follow-up, indicating a complete reliance on exogenous insulin and failure of the pancreas to produce insulin seen with type-1 DM. The patient's HbA1c of 13.3 indicates a chronic state of DM, though COVID-19 certainly contributed to establishing NODM and DKA likely by wiping the remaining function of the Beta-cells in the pancreas. This uncommon case presentation demonstrates that even mild COVID-19 can induce DKA, so it is imperative that further research be conducted on its mechanism and prevention in the future.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"293 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76482210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: The Great Masquerader","authors":"S. Patel, V. Villgran, M. Young","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4099","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4099","url":null,"abstract":"Introduction Reverse-transcriptase polymerase chain reaction testing (RT-PCR) remains the mainstay in diagnosing SARS-CoV-2. Though a positive result is highly specific for the virus, the false negative rate of the test can vary from 20% to 100%. This can have implications including, but not limited to, delay in treatment, improper management, and more costly and invasive testing. We present a case of a 54 year old male who presented for hypoxic respiratory failure diagnosed with SARS-CoV-2 on bronchoalveolar lavage (BAL) after extensive workup including 5 negative nasopharyngeal RT-PCR SARS-CoV-2 tests (NP RT-PCR). Case The patient is a 54 year old male with a past medical history significant for morbid obesity and well controlled asthma who presented for dyspnea on exertion. Throughout the patient's hospitalization, his oxygen requirements rapidly increased leading to a short course of ventilator support. CT angiogram of the chest on presentation did not show evidence of pulmonary embolism however did show bilateral multi-lobar ground glass opacities. The patient admitted to recently removing an old carpet at work but denied any other significant inhalational exposures. Dozens of his co-workers recently tested positive for SARS-CoV-2. Extensive workup including respiratory virus panel, 5 NP RT-PCR tests one week apart, basic rheumatologic serologies, and hypersensitivity pneumonitis panel were all unremarkable. Treatment for community acquired pneumonia was completed without improvement. Empiric treatment with steroids was started. BAL and trans-bronchial biopsies were initially unremarkable (Table 1). Repeat imaging demonstrated multiple sub-segmental pulmonary emboli. RT-PCR of the BAL specimen and serum antibodies for SARS-CoV-2 were collected, both of which resulted positive. The patient was eventually discharged on oral anticoagulation, a short prednisone taper, and 2L oxygen via nasal cannula on exertion with scheduled outpatient follow-up. Conclusion NP RT-PCR has become the gold standard diagnostic test for SARS-CoV-2, but it does not come without imperfections. Timing of the test in relation to symptoms, assay limit of detection, and sample collection technique all affect the results. Our patient's clinical presentation, known recent exposure, and imaging findings increased his probability of having SARS-CoV-2. However, NP RT-PCR was negative on 5 separate occasions. Limitations of this test may therefore extend beyond our current understanding. After obtaining SARS-CoV-2 diagnosis from the BAL, this obviated the need for a thoracoscopic biopsy and treatment with prolonged steroids. BAL RT-PCR SARS-CoV-2 testing consequently may play a necessary role in such patients with negative NP RT-PCR testing.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89625569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathogical Lung Patterns of SARS CoV2 Infection","authors":"A. E. Martínez, L. F. Enciso, P. Torres, J. Piraquive, G. Diaz, E. Cortes, C. Rodriguez","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4077","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4077","url":null,"abstract":"INTRODUCTION: residual lung injury in patients recovering from COVID-19 information is scarce. Herein, we present a previous confirmed SARS-CoV2 infection case series including five patients, who underwent either open or transbronchial lung biopsy due to no clinical improvement. DESCRIPTION: Case 1: a 73-year-old male patient initially asymptomatic, with positive RT-PCR after transurethral resection of the prostate. Consulted for dyspnea and room air desaturation after 24 days during postoperative. Chest computed tomography reported findings compatible with organizing pneumonia, then a transbronchial biopsy was performed confirming diagnosis. Case 2: a 48-year-old male patient with COVID-19 pneumonia who required 14 days hospitalization. He was readmitted after 25 days since initial symptoms due to dyspnea and room air desaturation with a chest CT that revealed findings suggestive of pulmonary fibrosis. Therefore, an open lung biopsy was performed with a probable usual interstitial pneumonia pattern report. Case 3: a 86-year-old male patient, with initial mild COVID-19 infection who later progressed to severe pneumonia requiring high levels of supplemental oxygen. At 18 days of admission, due to persistent clinical compromise, a chest CT was performed with findings of organizing pneumonia. Therefore, he was taken to transbronchial lung biopsy that revealed non-specific interstitial pneumonia in the fibrosing phase. Case 4: a 61-year-old male patient with HIV/AIDS infection presented acute respiratory distress syndrome due to severe COVID-19 pneumonia with inability to withdraw invasive mechanical ventilation after one month. An open lung biopsy was performed with histopathology diagnosis of diffuse alveolar damage in the proliferative phase.Case 5: 41-year-old male patient with severe COVID-19 pneumonia requiring invasive mechanical ventilation, with persistent use of high levels of supplemental oxygen after 30 days since symptomatic. The chest CT suggested pulmonary fibrosis;therefore, an open lung biopsy was performed and confirmed Non-Specific Interstitial Pneumonia. DISCUSSION: to date, reports of interstitial lung disease due to COVID-19 refer to imaging findings or post-mortem histopathological studies which have been relatively limited given the strict guidelines and restrictions for performing bronchoscopies and lung surgery during the pandemic. The foregoing highlights the importance of tissue analysis under rigorous safety protocols in order to provide an early detection of interstitial lung involvement secondary to SARS-CoV-2 infection and then evaluate a prolonged steroid treatment recommendation.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90394900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guillain-Barre Syndrome Secondary to SARS-CoV-2","authors":"D. Chaudhary, D. Norton","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4071","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4071","url":null,"abstract":"Guillain-Barre Syndrome (GBS) is an acute autoimmune disorder that is provoked by a preceding infection. It is characterized by progressive, ascending, symmetrical muscle weakness accompanied by hyporeflexia or areflexia. We describe two cases of GBS associated with COVID-19. 36-year-old Hispanic female presented ten days after diagnosis of COVID-19 with symptoms of headache, bilateral leg and facial weakness, and facial paresthesias for five days. Within 24 hours of admission, she developed areflexia and progressive bulbar and appendicular weakness. Nerve conduction study and electromyography were consistent with demyelinating form of GBS. Due to difficulty with clearing oral secretions, patient was intubated two times during the hospitalization. 79-year-old Caucasian female presented with progressive weakness, weight loss and fevers. She was diagnosed with COVID-19 on the day of admission. She had paralysis of all four extremities with dysphagia and required intubation. She was extubated and re-intubated two more times due to worsening hypoxia and stridor which led to placement of a tracheostomy tube. Both our patients developed features of dysautonomia, including hypotension and tachycardia. Severe respiratory muscle weakness and dysphagia led to recurrent intubations. Their CT head and MRI brains were negative for facial nerve enhancement. Lumbar punctures in both revealed albuminocytologic dissociation. Plasma exchange was initiated in both females immediately after first intubation for total duration of five days. Upon outpatient follow up, they had significant improvement in motor function. Common precipitants of GBS are Campylobacter jejuni, EBV, CMV, HIV and Zika virus. Clearly, GBS is an infrequent complication of COVID-19. It is possible that SARS-CoV-2 evokes an immune response against peripheral nerve components leading to acute polyneuropathy of heterogenous presentation. Typically, demyelinating and axonal forms of GBS have been described. However, in our cases, both had demyelinating features including symmetric weakness with predominant bulbar symptoms of dysphagia and dysphonia. These cases highlight that GBS is a potential neurological complication of COVID-19 that physicians must be aware of. Thorough daily neurological exam is critical, and early recognition of GBS symptoms may prompt regular evaluation of negative inspiratory force and vital capacity. This may lead to early initiation of intravenous immunoglobulin (IVIG) or plasma exchange leading to improvement in motor symptoms thus avoiding ventilatory support. Plasma exchange should be considered as a first line treatment in COVID-19 patients since high concentrations of IVIG can lead to increased blood viscosity in these patients who are already at increased risk for thrombotic complications.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81593457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Pneumothorax with or Without Pulmonary Cysts in Patients Diagnosed with Covid-19 Pneumonia","authors":"L. F. Jiménez, J. Pedraza, J. R. L. Peña, M. A. Izquierdo, J. Carrillo, V. Rivillas","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4072","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4072","url":null,"abstract":"Introduction Covid-19 is a recent outbreak of pneumonia caused by severe respiratory syndrome coronavirus (SARS-CoV2). It affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Computed tomography (CT) plays a key role in diagnosis, the most common findings are bilateral, peripheral and basal ground-glass opacities. Pneumothorax secondary to SARS-CoV2 infection is rare and seems to develop later in the course of the disease, its mechanism is not completely understood. There are several reports about Covid-19 and pneumothorax, but few descriptions associated with pulmonary cysts. We describe seven cases of pneumothorax in patients with Covid-19, some of them with pulmonary cysts. Case descriptions We found a series of seven patients with Covid-19 pneumonia with pneumothorax, some as the initial presentation and some developing after the course of the disease, two to three weeks after initial symptoms. Patients were male, most of them in their fifties, two were former smokers and two had COPD. Only one patient had mechanical ventilation, two of them had pulmonary cysts in the CT scan which were not documented before. A Multifocal upper lobe consolidations. B. 29 days later. Left upper-lobe subpleural cystic lesions, ground-glass opacities, right pneumothorax. Discussion The course of Covid-19 depends on the damage caused by the virus and the host's immune response. CT scan is of great value in diagnosis and monitoring of progression and complications. The most common patterns are ground-glass opacification (88%), peripheral distribution (76%), bilateral (87.5%) and multilobe involvement (78.8%). Pneumothorax or cysts in Covid-19 have been described in few case reports. Pneumothorax seems to occur after two weeks of symptom onset, predominantly in male patients. Liu et al. described a series of two men with pneumothorax and peripheral pulmonary cysts after 26 and 40 days of symptom onset;cysts decreased in number and size in subsequent images. Other reports have described cysts or bullae. Pneumothorax seems to develop later in the course of the disease and they are most likely related to the reparation process. Mechanical ventilation with positive pressure is not associated with all cases. The pathogenesis of pulmonary cysts formation in Covid-19 is not well understood. Proposed mechanisms of cystic lung disease include necrosis due to ischemia, remodeling of interstitial matrix, and bronchial obstruction with distal overinflation phenomenon. Information regarding mechanism of pneumothorax in patients with lung infection secondary to Covid-19 is not yet completely understood, but cysts formation may play a role.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76124195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clot in Transit and Pulmonary Embolism in COVID-19","authors":"B. Gillespie, E. Solomon, A. Carpio","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4109","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4109","url":null,"abstract":"Clot in Transit in COVID-19 Introduction: Thromboembolism is a known complication of COVID-19, frequently occurring in patients receiving deep venous thrombosis (DVT) prophylaxis. This case report describes a patient with COVID-19 on DVT prophylaxis who had no other risk factors and developed a pulmonary embolism (PE) and subsequently was found to have a clot in transit in the right ventricular outflow tract on echocardiography. Case Report: 53-year-old male with no previous history of tobacco use, venous thromboembolism, malignancy, or clotting disorder was admitted with acute hypoxemic respiratory failure due to COVID-19. On initial examination, the patient was found to be hypoxic and tachycardic, requiring high flow nasal cannula. Chest x-ray showed multifocal airspace opacities consistent with COVID-19 pneumonia. CT pulmonary angiography was performed due to hypoxia and tachycardia, which revealed no evidence of PE. Laboratory results showed elevated inflammatory markers and a D-dimer of 1,700. The patient was admitted and started on dexamethasone, remdesivir, and subcutaneous heparin for DVT prophylaxis. The patient improved and oxygen was weaned down. On day 6 of hospitalization the patient developed acute dyspnea, worsening hypoxia, and tachycardia. Repeat CT pulmonary angiogram revealed multiple PE and therapeutic enoxaparin was started. An echocardiogram was performed and revealed an enlarged right ventricle and a large multi-lobulated hyperechoic mass in the right ventricular outflow tract, consist with a clot in transit. Interventional Radiology successfully performed aspiration thrombectomy, and the patient quickly improved and was discharged home on Apixaban. Discussion: As COVID-19 patients often present with hypoxemic respiratory failure and elevated D-dimer, it can be challenging for physicians to determine who should be screened for the presence of PE. Our case demonstrates the severity of hypercoagulability in COVID-19 and the importance of maintaining high suspicion for thromboembolism in COVID-19, even in patients receiving appropriate DVT prophylaxis and without risk factors. SARS-CoV-2 has been shown to bind to ACE2 on platelets and enhance thrombosis, indicating that infection itself can lead to DVT or PE. Even patient under guideline directed DVT prophylaxis frequently develop venous thromboembolism. Further investigation into how to prevent and catch pulmonary embolism in COVID-19 patients is needed. Methods such as daily D-dimer level trending, may be helpful in identifying patients at higher risk of developing PE or DVT but more research is needed to identify ideal cutoffs and DVT prophylaxis in these patients.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76460381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Latent Tuberculosis Reactivation in the Setting of COVID-19 Infection","authors":"G. Lee, J. Stoll, I. El Husseini","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4079","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4079","url":null,"abstract":"Introduction For decades, tuberculosis (TB) remained the leading cause of mortality due to a single infectious agent globally. In 2020, mortality due to the coronavirus disease 2019 (COVID-19) pandemic exceeded annual rates of death from TB. The impact of active COVID-19 and TB co-infection remain unclear. We present one of the first documented cases of active TB in the setting of COVID-19 infection in the United States. Case Report A 49-year-old man with a past medical history of mediastinal gray zone lymphoma and hypertension presented to the emergency room with a four-day history of diarrhea and hematochezia. The patient immigrated from Vietnam in 1995. Computed tomography imaging revealed thickening of the sigmoid wall, and bilateral pulmonary ground glass opacities consistent with COVID-19 pneumonia, which was confirmed by polymerase chain reaction (PCR). He was also neutropenic from recent chemotherapy. On admission, he began experiencing worsening hypoxia with exertion, and was started on remdesivir and dexamethasone for COVID-19 infection. Serial chest radiographs revealed worsening bibasilar opacities. He continued to have higher oxygen requirements and maxed out on high-flow nasal cannula and non-rebreather with 88-90% oxygen saturation, requiring transfer to the intensive care unit. A complete infectious workup was performed at this point. Cytomegalovirus PCR was positive at 1486IU and was started on ganciclovir. A bronchoscopy was performed but all testing was negative, including that for acid-fast bacilli (AFB) smear. The patient continued to become increasingly hypoxic, acidotic, and septic, and eventually underwent tracheostomy. Twenty days post-bronchoscopy, cultures from the bronchoalveolar fluid came back positive for Mycobacterium tuberculosis (MTB). A new sputum sample was sent and was found to be smear positive (2+ AFB) and MTB PCR positive. The patient was initiated on rifampin, isoniazid, pyrazinamide, and ethambutol therapy. Unfortunately, the patient continued to decompensate and was unable to be weaned off the ventilator. Comfort care was initiated by the family and the patient passed away on hospital day 68. Discussion The patient had several risk factors for latent TB reactivation, including malignancy, long-term corticosteroid use, and COVID-19 infection. Early research has shown that risk of death and recovery time with COVID-19 may be higher in patients with previous or active TB compared to those without. In patients with severe COVID-19 pneumonia and multiple risk factors for immunosuppression, latent TB reactivation should be considered in addition to secondary superinfection.","PeriodicalId":23169,"journal":{"name":"TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76611319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}