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

Covid-19 vaccine production and tariffs on vaccine inputs Covid-19疫苗生产和疫苗投入物关税

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-10-08 DOI: 10.30875/6bf3bdf6-en

引用次数: 0

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-10-08 DOI: 10.30875/12c628a5-en

引用次数: 2

Indicative list of trade-related bottlenecks and trade-facilitating measures on critical products to combat covid-19 抗击covid-19关键产品的贸易瓶颈和贸易便利化措施指示性清单

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-07-20 DOI: 10.30875/716a0e13-en

Devin McDaniels

This information note seeks to facilitate access to information on possible trade-related bottlenecks and trade-facilitating measures on critical products to combat COVID-19, including inputs used in vaccine manufacturing, vaccine distribution and approval, therapeutics and pharmaceuticals, diagnostics and medical devices. It is not meant to be an exhaustive list of all specific trade measures, nor does it make any judgement on the effect or significance of the reported bottlenecks, nor on the desirability of implementing any of the suggestions on trade-facilitating measures.3

本信息说明旨在便利获取有关可能出现的贸易瓶颈和抗击COVID-19关键产品贸易便利化措施的信息，包括用于疫苗制造、疫苗分销和批准、治疗和药品、诊断和医疗器械的投入物。2 .本报告并不打算详尽地列出所有具体的贸易措施，也不对所报告的瓶颈的影响或重要性作出任何判断，也不对执行任何关于贸易便利措施的建议的可取性作出任何判断

引用次数: 4

Joint Indicative List of Critical COVID-19 Vaccine Inputs for Consultation 供协商的COVID-19关键疫苗投入物联合指示性清单

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-07-07 DOI: 10.30875/ba1fe3c9-en

Dayong Yu

引用次数: 1

Improving trade data for products essential to fight covid-19 改善抗击covid-19所需产品的贸易数据

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-07-01 DOI: 10.30875/cc1b9379-en

引用次数: 0

An Unusual Case of a COVID19-Associated Solitary Pulmonary Nodule 新冠肺炎相关孤立性肺结节1例

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-05-01 DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4103

A. Vaccarello, E. Charley, C. Jagadeesan, A. Talon, J. Munoz, M. Irandost, B. Varda, A. Saeed

Introduction: Solitary pulmonary nodules (SPN) are commonplace and often incidental findings on diagnostic imaging such as computed tomography (CT) of the thorax. A SPN is defined as a single lung opacity of less than 3cm in size. They present a diagnostic dilemma as differentials are broad and range from benign to malignant. Here, we present a case of a SPN in an patient with SARS-CoV-2 infection. Case Description: A 33 year-old female with history of recreational marijuana use presented to the hospital with right-sided flank pain, dysuria, fevers, and nausea for four days. Upon presentation, she was afebrile with stable vital signs and SpO2 97% on ambient air. Physical exam was remarkable only for flank and suprapubic tenderness. A diagnosis of pyelonephritis was made and confirmed with CT of the abdomen which also detected a left lower lobe subpleural nodular consolidation. Follow-up chest CT better characterized the lesion as a 2.2 x 1.2 cm ground glass opacity (GGO) in the posterior left lower lobe without effusion, pneumothorax, or regional lymphadenopathy. Coccidioides serology was negative, however, routine COVID-19 testing found the patient to be positive for SARS-CoV-2. She underwent successful treatment for pyelonephritis and was discharged with instructions to follow up in pulmonology clinic. At follow up, she denied any interval development of respiratory symptoms. Repeat chest CT four months later showed complete resolution of the lesion and she was discharged from pulmonology clinic. Discussion: Since the advent of COVID-19, a plethora of radiologic findings have been noted in patients with known infections. Chest CT offers insight into clinical staging of diseas e and temporal evolutions of CT findings correlate with disease severity. Typical features include bilateral peripheral GGO, crazy paving pattern, airspace consolidations, traction bronchiectasis, and bronchovascular thickening. Atypical findings include mediastinal lymphadenopathy, pleural effusions, multiple small nodules, tree-in-bud, pneumothorax, and cavitation. Though not typical and seemingly underreported, a SPN may also indicate a very early infectious stage in the absence of respiratory symptoms. For our patient, Fleischner guidelines suggest a follow-up CT at 6-12 months but such a strategy would surely fail to detect development of pneumonia given the speed at which COVID-19 progresses, and possibly miss the window on early outpatient interventions and infection prevention. Instead, this case highlights the importance of shorter interval repeat chest imaging in patients with incidental SPN and SARS-CoV-2 infection as a means to monitor for resolution or progression requiring further evaluation and treatment.

简介:孤立性肺结节(SPN)是常见的，通常是胸部计算机断层扫描(CT)等诊断影像的偶然发现。SPN定义为单个肺不透明，大小小于3cm。他们提出了一个诊断困境，因为鉴别是广泛的，范围从良性到恶性。在这里，我们报告了一例SARS-CoV-2感染患者的SPN。病例描述:一名33岁女性，有娱乐性大麻使用史，因右侧腹部疼痛、排尿困难、发烧和恶心4天就诊。入院时，患者无发热，生命体征稳定，环境空气中SpO2含量为97%。体格检查仅在侧腹和耻骨上压痛方面表现突出。诊断为肾盂肾炎，腹部CT也发现左下叶胸膜下结节实变。随访胸部CT更好地表征病变为左侧下叶后2.2 x 1.2 cm磨玻璃影(GGO)，无积液、气胸或局部淋巴结病。球虫血清学结果为阴性，但常规COVID-19检测发现患者对SARS-CoV-2呈阳性。她接受了成功的治疗肾盂肾炎，出院后指示到肺科诊所随访。随访时，她否认有任何间隔性呼吸道症状。4个月后复查胸部CT显示病灶完全消退，出院。讨论:自COVID-19出现以来，在已知感染的患者中发现了大量放射学表现。胸部CT可以深入了解疾病的临床分期以及与疾病严重程度相关的CT表现的时间演变。典型特征包括双侧外周GGO、疯狂铺装模式、空域实变、牵引性支气管扩张、支气管血管增厚。不典型表现包括纵隔淋巴结病、胸腔积液、多发小结节、树状芽状、气胸和空化。虽然不典型且似乎未被报道，但SPN也可能表明在没有呼吸道症状的情况下处于非常早期的感染阶段。对于我们的患者，Fleischner指南建议在6-12个月时进行随访CT，但鉴于COVID-19的发展速度，这种策略肯定无法检测到肺炎的发展，并且可能错过早期门诊干预和感染预防的窗口期。相反，该病例强调了在偶发SPN和SARS-CoV-2感染的患者中，较短间隔重复胸部成像作为监测需要进一步评估和治疗的缓解或进展的手段的重要性。

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引用次数: 0

The COP Out Diagnosis: A Rare Case of CMV Pneumonitis and COVID19 Organizing Pneumonia COP Out诊断:一例罕见的巨细胞病毒肺炎和covid - 19组织性肺炎

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-05-01 DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4084

J. Khosa, I. C. Jun, K. Wei

Introduction: Cytomegalovirus (CMV) pneumonitis is well known as a life-threatening condition in immunocompromised risk groups and has been implicated in the development of cryptogenic organizing pneumonia (COP). We present a unique case of CMV pneumonitis confounded by COP related to a recent SARS-Coronavirus 19 (COVID19) infection. It is important for clinicians to recognize underlying red herrings or potential anchoring bias in the differential of COVID19 sequelae including secondary opportunistic infections. Description: A fifty-five year old gentleman presented with fevers, cough, dyspnea, and myalgias for nine days which progressed to acute hypoxemic respiratory failure. Computed tomography (CT) of the chest showed diffuse ground glass airspace disease with hilar lymphadenopathy and left lower basal consolidation (Figure 1). Diagnostic differentials considered included community acquired pneumonia and COVID19 bronchopneumonia. Empiric antibiotics, Anakinra, and systemic steroids were started. Initial microbiologic studies were negative for bacterial, fungal or viral etiologies, as were serologic testing for autoimmune diseases. COVID19 nucleic acid amplification probes were negative on five separate swabs. The patient failed to clinically improve and ultimately was referred for surgical lung biopsy. The biopsy revealed intranuclear viral inclusions and findings of chronic fibrosing interstitial organizing pneumonia with CMV pneumonitis. Serum CMV polymerase chain reaction (PCR) showed a viral load of 2,520 IU/mL and COVID-19 specific serum IgG was later found to be positive. The patient was treated with therapeutic dose of ganciclovir for two weeks and given a longer steroid course for the organizing pneumonia. After a prolonged hospital stay, the patient was discharged home with tapered prednisone and supplemental oxygen. Discussion: The coexistence of COVID19 and CMV pneumonitis has reported to date in one other case to our knowledge (1,3). We hypothesize that COVID19 infection as evidenced by positive IgG could have served as the inciting event leading to the development of organizing pneumonia. Systemic steroids can induce a relative immunosuppressed state which predisposes to opportunistic infections like CMV pneumonitis. Alternatively, CMV can reactivate in critically ill patients (2). Of note, this case demonstrates the perils of confounding diagnoses and anchoring bias as our patient likely failed to respond clinically to systemic steroid therapy for COP while secondarily infected with CMV. This case highlights the need to consider other possible confounders in the diagnostic differential for COVID19 sequalae when patients are not responding adequately to empiric treatment and to evaluate more histopathologic or post-mortem examinations of COVID19 patients.

巨细胞病毒(CMV)肺炎在免疫功能低下的危险人群中是一种危及生命的疾病，并与隐源性组织性肺炎(COP)的发展有关。我们报告了一例独特的巨细胞病毒肺炎合并与最近的sars冠状病毒19 (covid - 19)感染相关的COP。临床医生必须认识到潜在的转移注意力或潜在的锚定偏见，以区分包括继发性机会性感染在内的covid - 19后遗症。描述:一位55岁的男士表现为发烧、咳嗽、呼吸困难和肌痛，持续9天，进展为急性低氧性呼吸衰竭。胸部CT示弥漫性磨玻璃空腔病变伴肺门淋巴结病变及左下基底实变(图1)。考虑的诊断鉴别包括社区获得性肺炎和covid - 19支气管肺炎。开始使用经验性抗生素、阿那白和全身性类固醇。最初的微生物学研究在细菌、真菌或病毒病因方面呈阴性，对自身免疫性疾病的血清学检测也呈阴性。5份拭子核酸扩增探针检测结果均为阴性。患者未能在临床上得到改善，最终被转介进行手术肺活检。活检显示核内病毒包涵体和慢性纤维化间质性肺炎合并巨细胞病毒肺炎。血清CMV聚合酶链反应(PCR)显示病毒载量为2520 IU/mL，随后发现COVID-19特异性血清IgG阳性。患者给予治疗剂量的更昔洛韦治疗两周，并给予较长的类固醇疗程治疗组织性肺炎。经过长时间的住院治疗后，患者出院回家，使用逐渐减少的强的松和补充氧气。讨论:据我们所知，迄今已有另一起病例报告了covid - 19和巨细胞病毒肺炎共存(1,3)。我们推测，以IgG阳性为证据的covid - 19感染可能是导致组织性肺炎发展的煽动事件。全身性类固醇可诱导相对免疫抑制状态，易发生机会性感染，如巨细胞病毒肺炎。另外，巨细胞病毒可以在危重患者中重新激活(2)。值得注意的是，该病例显示了混淆诊断和锚定偏差的危险，因为我们的患者在继发感染巨细胞病毒的情况下，可能对COP的全身类固醇治疗没有临床反应。这一病例突出表明，当患者对经验性治疗反应不充分时，有必要在诊断covid - 19后遗症时考虑其他可能的混杂因素，并对covid - 19患者进行更多的组织病理学或尸检检查。

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引用次数: 0

Relapse Versus Reinfection: A Case of Recurrence of COVID-19 Infection During Pregnancy 复发与再感染:1例妊娠期COVID-19感染复发

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-05-01 DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4100

B. J. Abuhalimeh, D. Dumford

Introduction The world has been experiencing a novel COVID-19 pandemic since December 2019. Since that time there has been rapid spread and considerable mortality and morbidity. The immunology of COVID-19 is still being determined in the general population as well as select groups such as pregnant females whose immune response may be altered. Here we present a case of questionable relapse vs reinfection of COVID-19 in a pregnant health care worker. Case description A 32 year old female healthcare worker, with no significant past medical history developed slight shortness of breath and loss of taste and smell soon after she discovered about her first pregnancy. She subsequently tested positive for COVID-19 in April 2020. At that time she was at six weeks gestation. She never developed a fever, cough, GI symptoms, malaise, muscle fatigue or sore throat. Because her symptoms were mild and stable, and she never required oxygen supplements, she was asked to quarantine at home, and to take the needed precautions. Telephone visits have been conducted daily to check on her clinical status and patient had access to pulse oximetry and thermostat and therefore has been keeping track of her vital signs and wellbeing. In May 2020 - one month after initial infection- she reported total clearance of her initial symptoms and she has been preparing to return to work. She however reported that she has had contact COVID-19 positive individuals. Because of that she has been retested prior to returning to work. Nasopharyngeal swab was performed and PCR was negative. Two weeks later, she reported acute onset on dyspnea on exertion, and loss of taste and smell. Nasopharyngeal swab was performed and PCR was positive. She experienced mild symptoms and was quarantined home. One month later, she reported resolution of symptoms and repeat COVID19 testing was negative. Discussion Studies have shown that post infection immunity has conferred for at least 3-6 month. Clinical course and prognosis of COVID19 in pregnancy has been found to be associated with more complications and rapid clinical deterioration. Hence, frequent ICU admissions and need for mechanical ventilation were noticed in pregnant COVID19 infected females, however, limited data is available on post infection immunity in pregnancy. Hence, it remains unknown if this presented patient has experienced relapse of an initial infection or if given her immunosuppressed state in setting of pregnancy she has re-acquired the infection.

自2019年12月以来，全球一直在经历一场新型COVID-19大流行。从那时起，疾病迅速蔓延，死亡率和发病率都很高。在普通人群以及免疫反应可能发生改变的孕妇等特定人群中，COVID-19的免疫学仍在确定中。在这里，我们报告了一例可疑的COVID-19复发与再感染孕妇卫生保健工作者。病例描述一名32岁女性卫生保健工作者，无明显既往病史，在发现首次怀孕后不久出现轻微呼吸短促、味觉和嗅觉丧失。随后，她于2020年4月被检测为COVID-19阳性。那时她已经怀孕六周了。她从未出现过发烧、咳嗽、胃肠道症状、不适、肌肉疲劳或喉咙痛。由于她的症状轻微而稳定，而且她从不需要补充氧气，因此她被要求在家隔离，并采取必要的预防措施。每天都进行电话访问以检查她的临床状况，患者可以使用脉搏血氧仪和恒温器，因此一直在跟踪她的生命体征和健康状况。2020年5月，即初次感染一个月后，她报告说，她的初步症状完全消除，并一直在准备重返工作岗位。然而，她报告说，她接触过COVID-19阳性的人。正因为如此，她在重返工作岗位之前重新接受了检测。鼻咽拭子检测，PCR结果为阴性。两周后，患者报告劳累时出现急性呼吸困难，味觉和嗅觉丧失。鼻咽拭子检测，PCR阳性。她出现了轻微的症状，并被隔离在家。一个月后，她报告症状消退，再次进行covid - 19检测呈阴性。研究表明，感染后免疫至少可维持3-6个月。新冠肺炎在妊娠期的临床病程和预后与并发症多、临床恶化快有关。因此，在感染covid - 19的怀孕女性中，注意到频繁的ICU住院和机械通气需求，然而，关于妊娠期感染后免疫的数据有限。因此，尚不清楚这名患者是否经历了最初感染的复发，或者如果在怀孕期间免疫抑制，她是否再次获得了感染。

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引用次数: 0

When Coronavirus Disease 2019 (COVID-19) Pneumonia Isn't Enough: A Rare Case of Bacterial Coinfection 当2019冠状病毒病(COVID-19)肺炎还不够时:罕见的细菌合并感染病例

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-05-01 DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4093

B. Anderson, A. Nathani, S. Ghamande

Introduction: Atypical bacterial coinfections, including more rare organisms such as Legionella pneumophila, can complicate coronavirus disease 2019 (COVID-19) infections. Care should be taken to avoid anchoring bias and ensure all bacterial coinfections are diagnosed and treated in patients with COVID-19. CASE REPORT: A 49-year-old male with no past medical history developed abdominal pain, diarrhea and cough on April 4, 2020. He tested positive for SARS-CoV 2 on April 6th given there were several people at his work that had recently contracted coronavirus disease 2019 (COVID-19). Over the next week he developed progressive fever, cough, anosmia, ageusia and then dyspnea with exertion which prompted him to seek medical care. Shortly after admission, he became more febrile, tachycardic and hypoxic requiring oxygen supplementation via high-flow nasal cannula. His oxygen requirements continued to worsen, and he was transferred to the ICU and intubated. His procalcitonin was elevated at 8.99 and he was started on empiric broad spectrum antibiotics. Tracheal aspirate was tested via PCR and returned positive for Legionella pneumophila. He also tested positive for Legionella urinary antigen. He received hydroxychloroquine for 7 days, IV doxycycline for 10 days, ceftriaxone for 6 days and piperacillin-tazobactam for 2 days. He gradually improved and was successfully weaned off supplemental oxygen. He was discharged after a 10-day hospital stay with minimal respiratory symptoms. DISCUSSION: Among patients diagnosed with COVID-19, Legionella bacterial coinfection appears to be rare. In a systematic review published in July 2020, Rawson et al reported that only 8% (62/806) of patients diagnosed with COVID-19 were diagnosed with a bacterial pneumonia coinfection and found only one patient who had COVID-19 and Legionella. However, it has been reported that there may be an increased risk of Legionella infections during the COVID-19 pandemic due to water systems being used less often because of lockdown orders. In September 2020, De Giglio et al reported that a large Italian hospital found a significant increase in Legionella pneumophila isolates on routine water system testing in two of three wards which had been closed for over a month due to emergency reorganization. It remains important to keep Legionella bacterial co-infection on the differential when treating COVID-19 since it may require a longer treatment regimen than what is recommended for treating standard community acquired pneumonia. In addition, the pandemic response has the potential to increase the risk of legionella infections secondary to stagnant water systems in lockdowns.

非典型细菌共感染，包括更罕见的细菌，如嗜肺军团菌，可使2019冠状病毒病(COVID-19)感染复杂化。应注意避免锚定偏差，并确保对COVID-19患者的所有细菌合并感染进行诊断和治疗。病例报告:一名49岁男性，无既往病史，于2020年4月4日出现腹痛、腹泻和咳嗽。鉴于他工作的几个人最近感染了2019冠状病毒病(COVID-19)，他在4月6日的SARS-CoV检测呈阳性。在接下来的一个星期里，他出现了进行性发烧、咳嗽、嗅觉丧失、失语，然后是用力时呼吸困难，这促使他去看医生。入院后不久，患者出现发热、心动过速和缺氧，需要通过高流量鼻插管补充氧气。他的氧气需求继续恶化，他被转移到重症监护室并插管。他的降钙素原升高到8.99，他开始使用广谱抗生素。经PCR检测气管抽吸结果为嗜肺军团菌阳性。他的军团菌尿抗原检测也呈阳性。羟氯喹7天，强力霉素10天，头孢曲松6天，哌拉西林-他唑巴坦2天。他逐渐好转，并成功地停止了补充氧气。他在住院10天后出院，呼吸道症状很轻。讨论:在诊断为COVID-19的患者中，军团菌合并感染似乎很罕见。在2020年7月发表的一篇系统综述中，Rawson等人报告说，在被诊断为COVID-19的患者中，只有8%(62/806)被诊断为细菌性肺炎合并感染，只有1名患者同时患有COVID-19和军团菌。然而，据报道，在2019冠状病毒病大流行期间，由于封锁令导致供水系统的使用频率降低，军团菌感染的风险可能会增加。2020年9月，De Giglio等人报告称，意大利一家大型医院因紧急重组而关闭了一个多月的三个病房中，有两个病房在常规水系统检测中发现嗜肺军团菌分离株显著增加。在治疗COVID-19时，保持军团菌合并感染的区别仍然很重要，因为它可能需要比治疗标准社区获得性肺炎推荐的治疗方案更长的治疗方案。此外，大流行应对有可能增加军团菌感染的风险，继发于封锁期间的死水系统。

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引用次数: 1

Spontaneous Pneumomediastinum/Pneumothorax in Acute COVID-19 Pneumonia: A Case Report 急性COVID-19肺炎并发自发性纵隔气胸1例

TP100. TP100 UNEXPECTED COVID-19 CASE REPORTS

Pub Date : 2021-05-01 DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A4112

N. Sahu, J. Roy, E. Ernst, A. Zamir

Introduction Spontaneous pneumomediastinum, a rare condition in viral pneumonias, has been increasingly reported during the ongoing COVID-19 pandemic. Emerging literature suggests a higher incidence and mortality in COVID-19 patients with both a pneumothorax and pneumomediastinum. Early recognition and understanding of these complications are necessary to improve outcomes. We present a case of an older man initially diagnosed with mild COVID-19 symptoms who quickly progressed with increasing oxygen levels found to have a small pneumothorax and pneumomediastinum. Description A 77-year-old man with hypertension, obstructive sleep apnea on home continuous positive airway pressure (CPAP) therapy, and diagnosis of mild COVID-19 via reverse transcriptase polymerase chain reaction 1-week prior, presented to the emergency department for worsening shortness of breath. He was found to have a temperature of 101.5°F, heart rate of 103bpm, stable blood pressure, respiratory rate of 25 breaths/minute, and oxygen saturation of 70% on ambient air. He was placed on 15lpm mid-flow. Labs were significant for a white blood cell count of 14k/uL, hemoglobin 11.7g/dL, c-reactive protein 185 mg/L, pro- BNP of 637pg/mL, ferritin 802 ng/mL, lactic acid 2 mmol/L, procalcitonin of 0.84 ng/mL. He had a chest x-ray with bilateral perihilar and lower lobe infiltrates. He was started on dexamethasone, remdesivir, antibiotics, tocilizumab, and enoxaparin. His CPAP was held and continued on oxygen therapy. Discussion Pneumomediastinum, or air in the mediastinum, occurs through various etiologies categorized into secondary and spontaneous. Common secondary causes include blunt injuries by trauma, iatrogenic causes such as intubation, central lines, and chest operations, and finally, medical conditions such as interstitial lung disease, asthma, connective tissue disorders, and respiratory infections may be other causes (1). Several cases have been reported with spontaneous pneumomediastinum in patients with COVID-19, however, the exact etiology is unknown as none were placed on mechanical ventilation (2-5). One mechanism is likely due to the repetitive episodes of cough causing increased airway pressure leading to alveolar rupture in already extensively damaged alveoli and proximal gas leakage (2). Based on one autopsy report, there were findings of desquamation of pneumocytes and hyaline membrane formation indicating early acute respiratory distress syndrome (6). In another case series, barotrauma from higher PEEP (positive end-expiratory pressure) with the use of CPAP is potentially another mechanism (7). Careful consideration for these complications should occur in patients with progressive forms of COVID-19, ensuring cough suppression, use of anti-emetics, diuretics and low PEEP strategy to help mitigate this previously rare phenomenon.

自发性纵隔肺炎是病毒性肺炎中的一种罕见疾病，在持续的COVID-19大流行期间，越来越多地报道了自发性纵隔肺炎。新出现的文献表明，同时伴有气胸和纵隔气肿的COVID-19患者的发病率和死亡率更高。早期认识和了解这些并发症对于改善预后是必要的。我们报告了一例最初被诊断为轻度COVID-19症状的老年男性，随着氧气水平的增加，病情迅速发展，发现有小气胸和纵隔气肿。一名77岁男性，高血压，阻塞性睡眠呼吸暂停，在家持续气道正压通气(CPAP)治疗，1周前通过逆转录酶聚合酶链反应诊断为轻度COVID-19，因呼吸急促加重而就诊于急诊室。患者体温101.5°F，心率103bpm，血压稳定，呼吸频率25次/分钟，环境空气氧饱和度70%。他被安排在下午15点。白细胞计数14k/uL，血红蛋白11.7g/dL, c反应蛋白185 mg/L，前BNP 637pg/mL，铁蛋白802 ng/mL，乳酸2 mmol/L，降钙素原0.84 ng/mL。胸片显示双侧肺叶周围及下肺叶浸润。他开始使用地塞米松、瑞德西韦、抗生素、托珠单抗和依诺肝素。他的CPAP维持并继续吸氧。纵隔气肿，或纵隔空气，有多种病因，分为继发性和自发性。常见的继发原因包括外伤造成的钝性损伤，医源性原因如插管、中央导管和胸部手术，最后，医学条件如间质性肺疾病、哮喘、结缔组织疾病和呼吸道感染可能是其他原因(1)。已经报道了几例COVID-19患者自发性纵隔气肿，然而，确切的病因尚不清楚，因为没有人使用机械通气(2-5)。一种机制可能是由于反复发作的咳嗽引起气道压力增加，导致已经广泛受损的肺泡破裂和近端气体泄漏(2)。根据一份尸检报告，发现肺细胞脱屑和透明膜形成表明早期急性呼吸窘迫综合征(6)。使用CPAP时较高的呼气末正压(呼气末正压)造成的气压创伤可能是另一种机制(7)。进行性COVID-19患者应仔细考虑这些并发症，确保咳嗽抑制、使用止吐剂、利尿剂和低呼气末正压策略，以帮助减轻这种以前罕见的现象。

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引用次数: 0