Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2004
P. Modi, B. Tuppekar, G. Nair, A. Uppe
Introduction: While most cases of COVID-19 recover completely within 2-6 weeks, some may develop complications including residual lung fibrosis. We describe an interesting case of late-onset post-COVID fibrosis that presented more than 4 months after the initial infection. Case: A 52-year-old male, an operating room technician by profession tested positive for COVID-19 after coming in contact with an infected patient early in May 2020. He was asymptomatic, vitally stable with no comorbidities, and was given a course of oral hydroxychloroquine, oseltamivir, and multivitamins. He remained asymptomatic for a week in the isolation ward with all investigations within normal range and was discharged home. HRCT thorax on the first follow-up at 2 weeks was normal and the patient resumed work as usual for the next 3 months. In mid-September, the patient presented to the outpatient clinic with a sudden onset of dyspnea on exertion that was progressive for 5 days with an oxygen saturation of 93% on room air. He was unable to perform a 6-minute walk test (6MWT). Spirometry was suggestive of moderate restriction and reduced DLCO. HRCT thorax at this point revealed bilateral extensive reticular opacities with few ground-glass opacities (GGO's) in all lobes bilaterally with a basal predominance. These findings were suggestive of late-onset of residual fibrosis more than 4 months after the initial infection. RT-PCR for COVID-19 was negative and ruled out re-infection. The patient was unwilling for admission and was started on oral pirfenidone, a tapering dose of oral prednisolone, and was advised home oxygen therapy. He did not take home oxygen but was compliant with oral steroids and antifibrotic. In the 7th-month of post-COVID follow-up, HRCT showed significant improvement as compared to the previous scan with reduced reticular opacities and minimal GGO's. The patient was symptomatically better with a saturation of 98% on room air and could perform 6MWT satisfactorily. Spirometry showed mild restriction and improvement in FVC. The antifibrotic dose was stepped up and the patient was referred for pulmonary rehabilitation. Discussion Despite an uncertain natural history of post-COVID sequelae, it has been observed that post-COVID fibrosis can develop as early as 3 weeks after the initial infection. This case was unique in its late presentation during the second post-COVID follow up at 4 months with normal imaging and clinical parameters during the first follow up. Hence a meticulous long-term follow-up should be done for all patients.
{"title":"Late Onset Post-COVID Fibrosis - A Case Report","authors":"P. Modi, B. Tuppekar, G. Nair, A. Uppe","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2004","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2004","url":null,"abstract":"Introduction: While most cases of COVID-19 recover completely within 2-6 weeks, some may develop complications including residual lung fibrosis. We describe an interesting case of late-onset post-COVID fibrosis that presented more than 4 months after the initial infection. Case: A 52-year-old male, an operating room technician by profession tested positive for COVID-19 after coming in contact with an infected patient early in May 2020. He was asymptomatic, vitally stable with no comorbidities, and was given a course of oral hydroxychloroquine, oseltamivir, and multivitamins. He remained asymptomatic for a week in the isolation ward with all investigations within normal range and was discharged home. HRCT thorax on the first follow-up at 2 weeks was normal and the patient resumed work as usual for the next 3 months. In mid-September, the patient presented to the outpatient clinic with a sudden onset of dyspnea on exertion that was progressive for 5 days with an oxygen saturation of 93% on room air. He was unable to perform a 6-minute walk test (6MWT). Spirometry was suggestive of moderate restriction and reduced DLCO. HRCT thorax at this point revealed bilateral extensive reticular opacities with few ground-glass opacities (GGO's) in all lobes bilaterally with a basal predominance. These findings were suggestive of late-onset of residual fibrosis more than 4 months after the initial infection. RT-PCR for COVID-19 was negative and ruled out re-infection. The patient was unwilling for admission and was started on oral pirfenidone, a tapering dose of oral prednisolone, and was advised home oxygen therapy. He did not take home oxygen but was compliant with oral steroids and antifibrotic. In the 7th-month of post-COVID follow-up, HRCT showed significant improvement as compared to the previous scan with reduced reticular opacities and minimal GGO's. The patient was symptomatically better with a saturation of 98% on room air and could perform 6MWT satisfactorily. Spirometry showed mild restriction and improvement in FVC. The antifibrotic dose was stepped up and the patient was referred for pulmonary rehabilitation. Discussion Despite an uncertain natural history of post-COVID sequelae, it has been observed that post-COVID fibrosis can develop as early as 3 weeks after the initial infection. This case was unique in its late presentation during the second post-COVID follow up at 4 months with normal imaging and clinical parameters during the first follow up. Hence a meticulous long-term follow-up should be done for all patients.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89270835","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1992
J. Chiles, S. Gandotra, D. Russell
INTRODUCTION: Uncertainty and discovery have been two fundamental processes in the response to the Covid-19 pandemic. We continue to recognize new manifestations and complications of this syndrome and its respiratory manifestations. Two recently recognized complications of Covid-19 are pneumothorax and pneumomediastinum with the interesting caveat that these diagnoses can be early manifestations, complications of mechanical ventilation, or can develop late in disease course after other clinical signs have long since begun to improve. Here, we present the case of a young man whose Covid-19 convalescence was disrupted by development of a pneumothorax with early tension physiology. CASE: Our patient was a 34-year-old white, nonsmoking male with a history of asthma and morbid obesity. Five weeks before presentation he was diagnosed with an asymptomatic case of Covid-19 after his symptomatic wife tested positive. Seven days later, he required admission to the ICU for worsening respiratory failure and spent a total of eight days in the ICU receiving oxygen via high-flow nasal cannula but did not require intubation. He was weaned to four liters of oxygen via nasal cannula after a ten day hospitalization and discharged home with instructions to follow up with his outpatient pulmonologist. He was convalescing well with reduced oxygen requirements until 18 days later, when he experienced the sudden onset of worsening dyspnea, prompting him to return to the emergency department. Initial imaging revealed a large left-sided pneumothorax with mediastinal shift and early tension physiology, for which emergency chest tube decompression was performed. His left lung re-expanded immediately after chest tube placement and he was able to rapidly tolerate a clamping trial followed by removal three days later. He was subsequently discharged home. DISCUSSION: The lingering sequelae of Covid-19 infection, including radiographic abnormalities, dyspnea, hypoxemic respiratory failure, and fatigue continue to present challenges for patients and providers. In this case, the sudden worsening of the patient's previously improving clinical course was a key clue to a new etiology of his dyspnea and resulted in appropriate treatment after discovery of the cause. Providers should remain vigilant for pneumothorax in patients with Covid-19, even after their discharge from the hospital.
{"title":"Covid Convalescence Interrupted","authors":"J. Chiles, S. Gandotra, D. Russell","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1992","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1992","url":null,"abstract":"INTRODUCTION: Uncertainty and discovery have been two fundamental processes in the response to the Covid-19 pandemic. We continue to recognize new manifestations and complications of this syndrome and its respiratory manifestations. Two recently recognized complications of Covid-19 are pneumothorax and pneumomediastinum with the interesting caveat that these diagnoses can be early manifestations, complications of mechanical ventilation, or can develop late in disease course after other clinical signs have long since begun to improve. Here, we present the case of a young man whose Covid-19 convalescence was disrupted by development of a pneumothorax with early tension physiology. CASE: Our patient was a 34-year-old white, nonsmoking male with a history of asthma and morbid obesity. Five weeks before presentation he was diagnosed with an asymptomatic case of Covid-19 after his symptomatic wife tested positive. Seven days later, he required admission to the ICU for worsening respiratory failure and spent a total of eight days in the ICU receiving oxygen via high-flow nasal cannula but did not require intubation. He was weaned to four liters of oxygen via nasal cannula after a ten day hospitalization and discharged home with instructions to follow up with his outpatient pulmonologist. He was convalescing well with reduced oxygen requirements until 18 days later, when he experienced the sudden onset of worsening dyspnea, prompting him to return to the emergency department. Initial imaging revealed a large left-sided pneumothorax with mediastinal shift and early tension physiology, for which emergency chest tube decompression was performed. His left lung re-expanded immediately after chest tube placement and he was able to rapidly tolerate a clamping trial followed by removal three days later. He was subsequently discharged home. DISCUSSION: The lingering sequelae of Covid-19 infection, including radiographic abnormalities, dyspnea, hypoxemic respiratory failure, and fatigue continue to present challenges for patients and providers. In this case, the sudden worsening of the patient's previously improving clinical course was a key clue to a new etiology of his dyspnea and resulted in appropriate treatment after discovery of the cause. Providers should remain vigilant for pneumothorax in patients with Covid-19, even after their discharge from the hospital.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82334064","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2011
L. Mikhaleva, O. Zayratyants, O. Vasyukova, G. N. Mednikov
Currently, there are only scarce data on pulmonary COVID-19 lesions in pregnant women in the literature although the disease hasn't spared any country. This study aimed to provide insight into this issue. We carried out a retrospective analysis of the clinical data, autopsy, and microscopic findings in 4 pregnant women with severe COVID-19. Patients were admitted 4-5 days after COVID-19 onset with fever, dry cough, and reduced saturation. Positive SARSCoV2 nasopharyngeal swab PCRs were obtained. Chest CT revealed bilateral 'ground glass' pneumonia, CT 3-4. The women were diagnosed with severe COVID-19 requiring ALV and ECMO. They underwent emergent C-section with subsequent therapy. Patient 1, 37 y.o., 28-29 gestation weeks (GW), had comorbid conditions-obesity and arterial hypertension, died on the 11th bed-day (BD) due to pulmonary embolism. Patient 2, 31 y.o., 27 GW, developed bacterial pneumonia and acute pansinusitis with multiple organ failure resulting in death on 15th BD. Patient 3, 22 y.o., 35 GW, had ventilatorassociated pneumonia, lymphopenia, thrombocytopenia, anemia, and phlebothrombosis as COVID-19 complications. Later, she developed sepsis, which resulted in a lethal outcome (on 26th BD). Patient 4, 38 y.o., 32 GW, was diagnosed with pneumothorax on the 10th BD requiring pleural cavity drainage. The disease was complicated by bacterial pneumonia leading to respiratory failure and death (on the 30th BD). At autopsy, all four women had 'shock lungs' and diffuse alveolar damage at microscopy. Microscopic evaluation of the 1st patient's lung specimens revealed hyaline membranes corresponding to exudative DAD phase combined with proliferative DAD signs. In the 2nd case, we observed a pronounced cytopathic effect resulting in 'ugly' multinucleated cell formation, and multiple hemosiderophages in the alveolar lumens, as well as alveolar and bronchial metaplasia, confirmed by positive CK5-6 IHC staining. Third patient lung specimens demonstrated organizing viral pneumonia (with interalveolar granulation tissue, numerous interalveolar siderophages, indicating an alveolar-hemorrhagic syndrome) combined with massive bacterial pneumonia. Organizing viral pneumonia with mature interalveolar granulation tissue and sarcoid-like granulomas was diagnosed in 4 patient. Clinical and morphological analysis demonstrated that COVID-19 pneumonia features are similar for pregnant and non-pregnant patients of the same age group. The proliferative DAD phase was detected in three of 4 cases. However, of special interest is the first case, in which a combination of DAD phases was determined. At the same time, no severe obstetric complications were identified, which we associate with the timely diagnosis and prevention measures.
{"title":"Lung Lesions in 4 Pregnant Women with Severe COVID-19 - Autopsy Case","authors":"L. Mikhaleva, O. Zayratyants, O. Vasyukova, G. N. Mednikov","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2011","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2011","url":null,"abstract":"Currently, there are only scarce data on pulmonary COVID-19 lesions in pregnant women in the literature although the disease hasn't spared any country. This study aimed to provide insight into this issue. We carried out a retrospective analysis of the clinical data, autopsy, and microscopic findings in 4 pregnant women with severe COVID-19. Patients were admitted 4-5 days after COVID-19 onset with fever, dry cough, and reduced saturation. Positive SARSCoV2 nasopharyngeal swab PCRs were obtained. Chest CT revealed bilateral 'ground glass' pneumonia, CT 3-4. The women were diagnosed with severe COVID-19 requiring ALV and ECMO. They underwent emergent C-section with subsequent therapy. Patient 1, 37 y.o., 28-29 gestation weeks (GW), had comorbid conditions-obesity and arterial hypertension, died on the 11th bed-day (BD) due to pulmonary embolism. Patient 2, 31 y.o., 27 GW, developed bacterial pneumonia and acute pansinusitis with multiple organ failure resulting in death on 15th BD. Patient 3, 22 y.o., 35 GW, had ventilatorassociated pneumonia, lymphopenia, thrombocytopenia, anemia, and phlebothrombosis as COVID-19 complications. Later, she developed sepsis, which resulted in a lethal outcome (on 26th BD). Patient 4, 38 y.o., 32 GW, was diagnosed with pneumothorax on the 10th BD requiring pleural cavity drainage. The disease was complicated by bacterial pneumonia leading to respiratory failure and death (on the 30th BD). At autopsy, all four women had 'shock lungs' and diffuse alveolar damage at microscopy. Microscopic evaluation of the 1st patient's lung specimens revealed hyaline membranes corresponding to exudative DAD phase combined with proliferative DAD signs. In the 2nd case, we observed a pronounced cytopathic effect resulting in 'ugly' multinucleated cell formation, and multiple hemosiderophages in the alveolar lumens, as well as alveolar and bronchial metaplasia, confirmed by positive CK5-6 IHC staining. Third patient lung specimens demonstrated organizing viral pneumonia (with interalveolar granulation tissue, numerous interalveolar siderophages, indicating an alveolar-hemorrhagic syndrome) combined with massive bacterial pneumonia. Organizing viral pneumonia with mature interalveolar granulation tissue and sarcoid-like granulomas was diagnosed in 4 patient. Clinical and morphological analysis demonstrated that COVID-19 pneumonia features are similar for pregnant and non-pregnant patients of the same age group. The proliferative DAD phase was detected in three of 4 cases. However, of special interest is the first case, in which a combination of DAD phases was determined. At the same time, no severe obstetric complications were identified, which we associate with the timely diagnosis and prevention measures.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75734984","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}
Pub Date : 2021-05-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1988
V. Pathak, S. Chalise
Introduction: Coronavirus Disease 2019 (COVID 19) is a viral illness caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We report a patient with COVID-19 pneumonia leading to ARDS and subsequent development of an alveolopleural fistula who was successfully treated with multiple endobronchial valves. Case: The Patient was a 55-year-old Hispanic male who presented with 2 days of dry cough and shortness of breath. Vital signs on admission showed an oxygen saturation of 68% on ambient air and respiratory rate of 30 breaths per minute. He was admitted with acute hypoxic respiratory failure and found to have a positive SARS-Cov2 infection. Initial CT chest without contrast showed diffuse bilateral ground-glass opacities. His oxygen requirement increased as well as his work of breathing requiring BiPAP, and subsequent intubation. On the 10th day of admission, he developed a right-sided pneumothorax, requiring chest tube placement. A tracheostomy was completed on day 14 for further ventilator weaning. On day 20, he developed persistent air leak concerning for an alveolopleural fistula, repeat CT chest concerning for a moderate-sized pneumothorax and findings concerning for post ARDS fibrotic lungs. He continued to have persistent air leak but was not deemed to be a surgical candidate hence he was referred for endobronchial valve placement to facilitate chest tube removal and ventilator weaning. Bronchoscopy was done on day 41 of admission. Total 6 endobronchial valves were placed (right middle and lower lobes). Over next few days his leak completely resolved. Patient was weaned off of positive pressure a week later to trach collar, and the chest tube was subsequently removed. Discussion: Alveolopleural fistula is a communication or fistula between a alveoli and the pleural space. Patient's with ARDS secondary to COVID-19 requiring high amounts of PEEP and are at higher risk in developing a pneumothorax. Endobronchial valves (EBV) have been used since 2005 to treat alveolopleural and bronchopleural fistula in patients who are not considered a good surgical candidate. This is the first documented use of an EBV in the setting of COVID-19 that we could find. The placement of the valves, allowed a significant reduction in the air leak. This assisted in the patient's breathing trials on the ventilator and tracheostomy collar trials by reducing the overall volume loss through the fistula, ultimately allowing the patient to successfully liberated from the ventilator and have his chest tubes removed.
{"title":"Use of Endobronchial Valve to Treat COVID-19 Adult Respiratory Distress Syndrome Related Alveolopleural Fistula","authors":"V. Pathak, S. Chalise","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1988","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1988","url":null,"abstract":"Introduction: Coronavirus Disease 2019 (COVID 19) is a viral illness caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We report a patient with COVID-19 pneumonia leading to ARDS and subsequent development of an alveolopleural fistula who was successfully treated with multiple endobronchial valves. Case: The Patient was a 55-year-old Hispanic male who presented with 2 days of dry cough and shortness of breath. Vital signs on admission showed an oxygen saturation of 68% on ambient air and respiratory rate of 30 breaths per minute. He was admitted with acute hypoxic respiratory failure and found to have a positive SARS-Cov2 infection. Initial CT chest without contrast showed diffuse bilateral ground-glass opacities. His oxygen requirement increased as well as his work of breathing requiring BiPAP, and subsequent intubation. On the 10th day of admission, he developed a right-sided pneumothorax, requiring chest tube placement. A tracheostomy was completed on day 14 for further ventilator weaning. On day 20, he developed persistent air leak concerning for an alveolopleural fistula, repeat CT chest concerning for a moderate-sized pneumothorax and findings concerning for post ARDS fibrotic lungs. He continued to have persistent air leak but was not deemed to be a surgical candidate hence he was referred for endobronchial valve placement to facilitate chest tube removal and ventilator weaning. Bronchoscopy was done on day 41 of admission. Total 6 endobronchial valves were placed (right middle and lower lobes). Over next few days his leak completely resolved. Patient was weaned off of positive pressure a week later to trach collar, and the chest tube was subsequently removed. Discussion: Alveolopleural fistula is a communication or fistula between a alveoli and the pleural space. Patient's with ARDS secondary to COVID-19 requiring high amounts of PEEP and are at higher risk in developing a pneumothorax. Endobronchial valves (EBV) have been used since 2005 to treat alveolopleural and bronchopleural fistula in patients who are not considered a good surgical candidate. This is the first documented use of an EBV in the setting of COVID-19 that we could find. The placement of the valves, allowed a significant reduction in the air leak. This assisted in the patient's breathing trials on the ventilator and tracheostomy collar trials by reducing the overall volume loss through the fistula, ultimately allowing the patient to successfully liberated from the ventilator and have his chest tubes removed.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81352188","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2010
B. Bangash, I. Makki, R. Girgis
Introduction: Persistent radiographic and pulmonary function abnormalities are increasingly recognized following Corona Virus Disease (COVID-19) pneumonia. We present a case of rapidly progressive pulmonary fibrosis in a Usual Interstitial Pneumonia (UIP) pattern. Successful lung transplantation was performed two months following COVID-19 infection. Description: 68 years old with known history of mild Interstitial Lung Disease (ILD) , not on home oxygen, initially presented in July 2020 with worsening shortness of breath and cough. There was a strong family history for Interstitial pulmonary fibrosis (IPF). Her last pulmonary function tests showed a Forced Expiratory Volume in one second (FEV1) of 2.24 Liters (99%) and Forced Vital Capacity of 2.69 Liters (92%). Her last High Resolution Computed Tomography (HRCT) showed chronic stable mild interstitial fibrosis. On admission, she was positive for COVID 19 on her Polymerase Chain Reaction (PCR). Initial CT chest showed diffuse new ground glass changes. She was treated with remdesavir, dexamethasone and antibiotics. She did not require endotracheal intubation and showed improvement in her symptoms. Unfortunately, she could not be weaned off oxygen and was discharged on six liters flow oxygen through a nasal cannula. She presented again to the hospital, one month later with worsening shortness of breath. Her PCR was negative for COVID 19. Her CT angiogram of thorax however showed interval worsening of her interstitial changes. An urgent inpatient evaluation for lung transplantation was completed and she deemed to be a suitable candidate. After 4 days into her stay, acute deterioration in her respiratory status developed with tachypnea and increased work of breathing requiring endotracheal intubation and mechanical ventilation. Repeat CT chest showed fibrotic interstitial disease with associated traction bronchiectasis and a large amount of ground glass. She was subsequently placed on veno-venous Extra Corporeal Membrane Oxygenation (VV ECMO) which allowed extubation. A donor offer for bilateral lungs was accepted after one day on ECMO. She successfully underwent bilateral lung transplant in September 2020. Her post-operative course was uncomplicated. She is doing well 3 months post transplant without evidence of cellular rejection. Her explant pathology showed Diffuse Alveolar Damage plus UIP Discussion: Persistent and progressive pulmonary fibrosis may develop following COVID-19 pneumonia. Risk factors may include underlying ILD and family history of IPF. In suitable candidates, lung transplantation is a viable option.
{"title":"Lung Transplant for Corona Virus Diseases (COVID-19) Pulmonary Fibrosis","authors":"B. Bangash, I. Makki, R. Girgis","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2010","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2010","url":null,"abstract":"Introduction: Persistent radiographic and pulmonary function abnormalities are increasingly recognized following Corona Virus Disease (COVID-19) pneumonia. We present a case of rapidly progressive pulmonary fibrosis in a Usual Interstitial Pneumonia (UIP) pattern. Successful lung transplantation was performed two months following COVID-19 infection. Description: 68 years old with known history of mild Interstitial Lung Disease (ILD) , not on home oxygen, initially presented in July 2020 with worsening shortness of breath and cough. There was a strong family history for Interstitial pulmonary fibrosis (IPF). Her last pulmonary function tests showed a Forced Expiratory Volume in one second (FEV1) of 2.24 Liters (99%) and Forced Vital Capacity of 2.69 Liters (92%). Her last High Resolution Computed Tomography (HRCT) showed chronic stable mild interstitial fibrosis. On admission, she was positive for COVID 19 on her Polymerase Chain Reaction (PCR). Initial CT chest showed diffuse new ground glass changes. She was treated with remdesavir, dexamethasone and antibiotics. She did not require endotracheal intubation and showed improvement in her symptoms. Unfortunately, she could not be weaned off oxygen and was discharged on six liters flow oxygen through a nasal cannula. She presented again to the hospital, one month later with worsening shortness of breath. Her PCR was negative for COVID 19. Her CT angiogram of thorax however showed interval worsening of her interstitial changes. An urgent inpatient evaluation for lung transplantation was completed and she deemed to be a suitable candidate. After 4 days into her stay, acute deterioration in her respiratory status developed with tachypnea and increased work of breathing requiring endotracheal intubation and mechanical ventilation. Repeat CT chest showed fibrotic interstitial disease with associated traction bronchiectasis and a large amount of ground glass. She was subsequently placed on veno-venous Extra Corporeal Membrane Oxygenation (VV ECMO) which allowed extubation. A donor offer for bilateral lungs was accepted after one day on ECMO. She successfully underwent bilateral lung transplant in September 2020. Her post-operative course was uncomplicated. She is doing well 3 months post transplant without evidence of cellular rejection. Her explant pathology showed Diffuse Alveolar Damage plus UIP Discussion: Persistent and progressive pulmonary fibrosis may develop following COVID-19 pneumonia. Risk factors may include underlying ILD and family history of IPF. In suitable candidates, lung transplantation is a viable option.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82028740","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2007
M. A. Ahmed, D. Verghese, Chenyu Sun, A. Mohan, D. Djondo
Coronavirus Disease 2019 (COVID-19) is known to have severe outcomes in patients with underlying comorbidities. Particularly, patients with compromised humoral immunity may face an increased risk for severe illness, as antibodies are essential for antiviral responses. Here, we present a COVID-19 patient with Bruton's X-linked agammaglobulinemia (XLA). A 46-year-old male with XLA receiving immunoglobulin replacement (IVIG) every three weeks, who contracted COVID-19 1-month ago, was admitted for 10-days of severe diarrhea and 3-days of exertional dyspnea. Repeat SARS-Co-V-2 PCR on admission was positive. Workup showed leukopenia and negative blood cultures. CT Chest Angiogram, performed for elevated D-dimer, revealed patchy bilateral ground-glass opacities, suggestive of viral/atypical pneumonia without pulmonary embolism. He received a 7-day course of Ceftriaxone and Azithromycin for community-acquired pneumonia and IVIG for low immunoglobulin levels. CT Abdomen and Pelvis, as well as a workup for infectious causes of diarrhea, were unremarkable. Colonoscopy ruled out microscopic and inflammatory colitis. Two stool SARS-Co-V-2 PCRs were negative. COVID IgG was negative, so he received COVID-19 Convalescent Plasma (CCP). Given his persistent fever spikes, bronchoscopy was performed, which was unremarkable;however, the bronchoalveolar lavage sample was positive for SARS-Co-V-2 PCR. The patient was hypoxemic and was started on Dexamethasone 6mg for 10-days. He was not a candidate for Remdesivir due to his delayed presentation. Tagged white blood cell (WBC) nuclear scan revealed mild pneumonia and mild sigmoid colonic WBC accumulation. The patient underwent prolonged hospitalization before improvement. As per the CDC's current recommendation to discontinue isolation 10-days from symptom onset, his isolation precautions were discontinued on the 16th day of hospitalization, 42 days after the first SARS-CoV-2 positive test. Given his underlying immunodeficiency, there was high suspicion that the patient was still infectious, putting frontline healthcare workers at risk. This was confirmed when an RT-PCR cell cycle threshold value (Ct) of 10.03 was obtained, which correlates to a highly culturable viral load and a highly infectious state. Isolation precautions were reinstated, and he was later discharged after another dose of CCP. Strict self-isolation for an additional ten days was advised. In summary, this patient with XLA had a lengthy hospital stay and prolonged viral shedding, likely due to an insufficient antibody response. In such patients, caution must be exercised when following the CDC recommendations for removing isolation precautions. RT-PCR Ct could be a valuable proxy in evaluating the state of infection and implementing appropriate infection control measures.
{"title":"The 'X' Factor: Exploring COVID-19 Viral Shedding in X-Linked Agammaglobulinemia. Can PCR Cell Cycle Threshold Play a Role?","authors":"M. A. Ahmed, D. Verghese, Chenyu Sun, A. Mohan, D. Djondo","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2007","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2007","url":null,"abstract":"Coronavirus Disease 2019 (COVID-19) is known to have severe outcomes in patients with underlying comorbidities. Particularly, patients with compromised humoral immunity may face an increased risk for severe illness, as antibodies are essential for antiviral responses. Here, we present a COVID-19 patient with Bruton's X-linked agammaglobulinemia (XLA). A 46-year-old male with XLA receiving immunoglobulin replacement (IVIG) every three weeks, who contracted COVID-19 1-month ago, was admitted for 10-days of severe diarrhea and 3-days of exertional dyspnea. Repeat SARS-Co-V-2 PCR on admission was positive. Workup showed leukopenia and negative blood cultures. CT Chest Angiogram, performed for elevated D-dimer, revealed patchy bilateral ground-glass opacities, suggestive of viral/atypical pneumonia without pulmonary embolism. He received a 7-day course of Ceftriaxone and Azithromycin for community-acquired pneumonia and IVIG for low immunoglobulin levels. CT Abdomen and Pelvis, as well as a workup for infectious causes of diarrhea, were unremarkable. Colonoscopy ruled out microscopic and inflammatory colitis. Two stool SARS-Co-V-2 PCRs were negative. COVID IgG was negative, so he received COVID-19 Convalescent Plasma (CCP). Given his persistent fever spikes, bronchoscopy was performed, which was unremarkable;however, the bronchoalveolar lavage sample was positive for SARS-Co-V-2 PCR. The patient was hypoxemic and was started on Dexamethasone 6mg for 10-days. He was not a candidate for Remdesivir due to his delayed presentation. Tagged white blood cell (WBC) nuclear scan revealed mild pneumonia and mild sigmoid colonic WBC accumulation. The patient underwent prolonged hospitalization before improvement. As per the CDC's current recommendation to discontinue isolation 10-days from symptom onset, his isolation precautions were discontinued on the 16th day of hospitalization, 42 days after the first SARS-CoV-2 positive test. Given his underlying immunodeficiency, there was high suspicion that the patient was still infectious, putting frontline healthcare workers at risk. This was confirmed when an RT-PCR cell cycle threshold value (Ct) of 10.03 was obtained, which correlates to a highly culturable viral load and a highly infectious state. Isolation precautions were reinstated, and he was later discharged after another dose of CCP. Strict self-isolation for an additional ten days was advised. In summary, this patient with XLA had a lengthy hospital stay and prolonged viral shedding, likely due to an insufficient antibody response. In such patients, caution must be exercised when following the CDC recommendations for removing isolation precautions. RT-PCR Ct could be a valuable proxy in evaluating the state of infection and implementing appropriate infection control measures.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91011719","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1995
G. Senyei, D. Nettlow, M. Nobari, R. Miller, G. Cheng
Introduction: Life-threatening hemoptysis is rare in patients diagnosed with COVID-19. Here, we describe a severe case of hemoptysis a patient with COVID-19 and the multi-modal approach to manage this condition. Case: A 57 year-old man with diabetes was admitted with hypoxemic respiratory failure due to COVID-19 pneumonia. Despite treatment with convalescent plasma, remdesivir and dexamethasone, he developed progressive respiratory failure eventually requiring VVECMO support on hospital day 8. He was started on heparin for therapeutic anticoagulation at this time. Anticoagulation was held on day 23 after large blood clots were suctioned via tracheostomy tube. CT revealed complete opacification of the bilateral lungs and major airways without evidence of acute arterial blushing (panel A). The patient underwent the first in a series of therapeutic bronchoscopies via a size 10 Shiley tracheostomy tube on day 28. Occlusive gelatinous blood clots were noted immediately upon entering the trachea. After failure of adequate clot evaluation with cryoprobe, a modified 24F chest tube was used as a suction catheter to achieve clot removal. After visualizing major airways, a bronchial blocker was positioned in the bronchus intermedius. Topical tranexamic acid was applied to sites of bleeding in the left upper lobe. Repeat bronchoscopy was performed on day 30, which showed new bleeding in the left lower lobe segments. An endobronchial blocker was repositioned in the left lower lobe and Surgicel was applied to ongoing bleeding sites within the right and left lung. Prior to repeat bronchoscopy, the patient was administered inhaled tranexamic acid three times daily due to findings of severely inflamed mucosa and diffused nature of bleed. On day 32, bronchoscopy revealed significantly improved bleeding. In-line suctioning was held in favor of daily diagnostic bronchoscopies to avoid suction trauma. Ultimately, the patient's bleeding resolved and he was eventually liberated from both ECMO and the ventilator with corresponding improvement on CT imaging (panel B). Discussion: We describe a case of a life-threatening hemoptysis in a patient with COVID-19 ARDS who was successfully managed using serial therapeutic bronchoscopies employing cryotherapy, mechanical tamponade, and pharamacologic coagulants to achieve hemostasis.
{"title":"A Multi-Modal Approach to Life-Threatening Hemoptysis in a Patient with COVID-19 ARDS","authors":"G. Senyei, D. Nettlow, M. Nobari, R. Miller, G. Cheng","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1995","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1995","url":null,"abstract":"Introduction: Life-threatening hemoptysis is rare in patients diagnosed with COVID-19. Here, we describe a severe case of hemoptysis a patient with COVID-19 and the multi-modal approach to manage this condition. Case: A 57 year-old man with diabetes was admitted with hypoxemic respiratory failure due to COVID-19 pneumonia. Despite treatment with convalescent plasma, remdesivir and dexamethasone, he developed progressive respiratory failure eventually requiring VVECMO support on hospital day 8. He was started on heparin for therapeutic anticoagulation at this time. Anticoagulation was held on day 23 after large blood clots were suctioned via tracheostomy tube. CT revealed complete opacification of the bilateral lungs and major airways without evidence of acute arterial blushing (panel A). The patient underwent the first in a series of therapeutic bronchoscopies via a size 10 Shiley tracheostomy tube on day 28. Occlusive gelatinous blood clots were noted immediately upon entering the trachea. After failure of adequate clot evaluation with cryoprobe, a modified 24F chest tube was used as a suction catheter to achieve clot removal. After visualizing major airways, a bronchial blocker was positioned in the bronchus intermedius. Topical tranexamic acid was applied to sites of bleeding in the left upper lobe. Repeat bronchoscopy was performed on day 30, which showed new bleeding in the left lower lobe segments. An endobronchial blocker was repositioned in the left lower lobe and Surgicel was applied to ongoing bleeding sites within the right and left lung. Prior to repeat bronchoscopy, the patient was administered inhaled tranexamic acid three times daily due to findings of severely inflamed mucosa and diffused nature of bleed. On day 32, bronchoscopy revealed significantly improved bleeding. In-line suctioning was held in favor of daily diagnostic bronchoscopies to avoid suction trauma. Ultimately, the patient's bleeding resolved and he was eventually liberated from both ECMO and the ventilator with corresponding improvement on CT imaging (panel B). Discussion: We describe a case of a life-threatening hemoptysis in a patient with COVID-19 ARDS who was successfully managed using serial therapeutic bronchoscopies employing cryotherapy, mechanical tamponade, and pharamacologic coagulants to achieve hemostasis.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"11 7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81253388","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1993
S. Golob, L. Winston, D. Manson, S. Fedyna
Introduction: Electronic-cigarette or vaping-product associated lung injury (EVALI) was first identified in August 2019, when U.S. public health officials noted a clinical syndrome of acute respiratory failure and systemic inflammation associated with the use of aerosolized nicotine and cannabinoids. The presence of lipid-laden macrophages on bronchiolar lavage is a specific but not sensitive histological finding of EVALI, which is often a diagnosis of exclusion. In 2020, the first cases of COVID-19, caused by SARS-CoV2 virus, were seen in the U.S. Both COVID-19 and EVALI can affect previously healthy individuals, manifesting with severe hypoxemia and systemic inflammation, posing diagnostic challenges in distinguishing the two syndromes. Secondary spontaneous pneumothorax is a well-described complication of COVID-19 yet is only rarely associated with EVALI, with only one published case report of EVALI complicated by pneumothorax. Here, we report a case of a 34-year-old man presenting with hypoxemic respiratory failure complicated by pneumothorax, initially thought to be from COVID-19 pneumonia, found ultimately to have EVALI associated diffuse alveolar damage. Case: In April 2020, a 34-year-old man presented with one week of myalgia, shortness of breath, and a reduced exercise tolerance. Social history was notable for extensive vaping. His exam was notable for hypoxemia requiring nonrebreather. Testing showed elevated inflammatory markers and diffuse bilateral opacities on chest radiography. Nasopharyngeal PCR was negative for SARS-CoV2. CT chest revealed dense consolidation with ground grass opacities and air bronchograms. Rheumatologic and infectious workup was unremarkable. Despite six negative SARS-CoV2 tests, he was treated for COVID-19 with empiric steroids and antibiotics for community-acquired pneumonia. On hospital day 3, he developed a right-sided pneumothorax requiring chest tube. On hospital day 12, he developed a left-sided pneumothorax and a second chest tube was placed. A presumptive diagnosis of pneumonitis and diffuse alveolar damage secondary to EVALI was made. Given non-healing bilateral pneumothoraces, on hospital day 32, he underwent chemical pleurodesis with doxycycline which was complicated by ARDS. He was intubated, suffered a PEA arrest from refractory hypoxemia, and emergently cannulated to VV ECMO. A head CT demonstrated diffuse cerebral edema suggestive of anoxic brain injury. After extensive goals of care discussions, care was withdrawn and the patient passed away. Discussion: EVALI, similar to COVID-19, is syndrome of severe acute hypoxemia and systemic inflammation. Both conditions have similar radiographic findings with ground glass opacities indicative of alveolar damage, histological findings of tracheobronchitis and diffuse alveolar damage, and can lead to secondary spontaneous pneumothoraces.
{"title":"E-Cigarette or Vaping-Product Associated Lung Injury Complicated by Spontaneous Pneumothoraces in the Setting of COVID-19 Pandemic","authors":"S. Golob, L. Winston, D. Manson, S. Fedyna","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1993","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1993","url":null,"abstract":"Introduction: Electronic-cigarette or vaping-product associated lung injury (EVALI) was first identified in August 2019, when U.S. public health officials noted a clinical syndrome of acute respiratory failure and systemic inflammation associated with the use of aerosolized nicotine and cannabinoids. The presence of lipid-laden macrophages on bronchiolar lavage is a specific but not sensitive histological finding of EVALI, which is often a diagnosis of exclusion. In 2020, the first cases of COVID-19, caused by SARS-CoV2 virus, were seen in the U.S. Both COVID-19 and EVALI can affect previously healthy individuals, manifesting with severe hypoxemia and systemic inflammation, posing diagnostic challenges in distinguishing the two syndromes. Secondary spontaneous pneumothorax is a well-described complication of COVID-19 yet is only rarely associated with EVALI, with only one published case report of EVALI complicated by pneumothorax. Here, we report a case of a 34-year-old man presenting with hypoxemic respiratory failure complicated by pneumothorax, initially thought to be from COVID-19 pneumonia, found ultimately to have EVALI associated diffuse alveolar damage. Case: In April 2020, a 34-year-old man presented with one week of myalgia, shortness of breath, and a reduced exercise tolerance. Social history was notable for extensive vaping. His exam was notable for hypoxemia requiring nonrebreather. Testing showed elevated inflammatory markers and diffuse bilateral opacities on chest radiography. Nasopharyngeal PCR was negative for SARS-CoV2. CT chest revealed dense consolidation with ground grass opacities and air bronchograms. Rheumatologic and infectious workup was unremarkable. Despite six negative SARS-CoV2 tests, he was treated for COVID-19 with empiric steroids and antibiotics for community-acquired pneumonia. On hospital day 3, he developed a right-sided pneumothorax requiring chest tube. On hospital day 12, he developed a left-sided pneumothorax and a second chest tube was placed. A presumptive diagnosis of pneumonitis and diffuse alveolar damage secondary to EVALI was made. Given non-healing bilateral pneumothoraces, on hospital day 32, he underwent chemical pleurodesis with doxycycline which was complicated by ARDS. He was intubated, suffered a PEA arrest from refractory hypoxemia, and emergently cannulated to VV ECMO. A head CT demonstrated diffuse cerebral edema suggestive of anoxic brain injury. After extensive goals of care discussions, care was withdrawn and the patient passed away. Discussion: EVALI, similar to COVID-19, is syndrome of severe acute hypoxemia and systemic inflammation. Both conditions have similar radiographic findings with ground glass opacities indicative of alveolar damage, histological findings of tracheobronchitis and diffuse alveolar damage, and can lead to secondary spontaneous pneumothoraces.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74575052","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2009
J. Kirupakaran, D. Valentine, A. Idowu, M. Jiménez, M. Okaikoi, A. M. Thida, G. Bahtiyar, G. Aristide, G. Rodriguez
INTRODUCTION Coronavirus-19 disease (COVID-19) caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to be a major cause of mortality worldwide. Advanced age and a number of chronic diseases have been investigated as risk factors for poor outcomes in patients with COVID-19. Likewise, Human Immunodeficiency Virus (HIV) has been proposed as a potential risk factor for COVID-19, however, the possible relationship between HIV and COVID-19 has remained difficult to fully elucidate due to a paucity of data. We describe a case series of 11 patients co-infected with HIV and SARS-CoV-2. CASE PRESENTATION Between March 20, 2020 and May 5, 2020, 11 patients with HIV were admitted for COVID-19at an underserved community hospital in Brooklyn, NY. . Patients ranged from 39 to 78 years of age. Seven patients were men and four patients were women. Seven patients were African American and four patients were Hispanic. All 11 patients possessed HIV RNA viral loads less than 40 copies/ml. The mean CD4 count was 556 cells/ml (range 171-1123 cells/ml). Nine patients were on antiretroviral therapy (ART). Six patients required invasive mechanical ventilation;five of the six patients died. Two of these five patients were not on ART, prior to admission and two of them developed acute respiratory distress syndrome during their hospital course. The mean length of stay was 10.9 days (range 2-21 days). Three of the six survivors were readmitted within 30 days for CHF exacerbation, bacterial pneumonia and COPD exacerbation. All three patients recovered without complications. At six-month follow-up, no mortalities were reported among the six surviving patients. DISCUSSION This case series presents a unique sample of African American and Hispanic patients co-infected with HIV and SARS-CoV-2. This is the first case series to report long term outcomes among minority population. The high mortality rate in this case series (45%) is also notable in comparison to prior research. This elevated mortality rate may reflect an increased burden of comorbidities in HIV patients. Further research is required to reveal if ART therapy reduces risk of poor outcomes, and if so, which regimen may confer protection against COVID-19.
{"title":"Clinical Features and Outcomes of Hospitalized Patients Co-Infected with COVID-19 and HIV: A Case Series","authors":"J. Kirupakaran, D. Valentine, A. Idowu, M. Jiménez, M. Okaikoi, A. M. Thida, G. Bahtiyar, G. Aristide, G. Rodriguez","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2009","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2009","url":null,"abstract":"INTRODUCTION Coronavirus-19 disease (COVID-19) caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to be a major cause of mortality worldwide. Advanced age and a number of chronic diseases have been investigated as risk factors for poor outcomes in patients with COVID-19. Likewise, Human Immunodeficiency Virus (HIV) has been proposed as a potential risk factor for COVID-19, however, the possible relationship between HIV and COVID-19 has remained difficult to fully elucidate due to a paucity of data. We describe a case series of 11 patients co-infected with HIV and SARS-CoV-2. CASE PRESENTATION Between March 20, 2020 and May 5, 2020, 11 patients with HIV were admitted for COVID-19at an underserved community hospital in Brooklyn, NY. . Patients ranged from 39 to 78 years of age. Seven patients were men and four patients were women. Seven patients were African American and four patients were Hispanic. All 11 patients possessed HIV RNA viral loads less than 40 copies/ml. The mean CD4 count was 556 cells/ml (range 171-1123 cells/ml). Nine patients were on antiretroviral therapy (ART). Six patients required invasive mechanical ventilation;five of the six patients died. Two of these five patients were not on ART, prior to admission and two of them developed acute respiratory distress syndrome during their hospital course. The mean length of stay was 10.9 days (range 2-21 days). Three of the six survivors were readmitted within 30 days for CHF exacerbation, bacterial pneumonia and COPD exacerbation. All three patients recovered without complications. At six-month follow-up, no mortalities were reported among the six surviving patients. DISCUSSION This case series presents a unique sample of African American and Hispanic patients co-infected with HIV and SARS-CoV-2. This is the first case series to report long term outcomes among minority population. The high mortality rate in this case series (45%) is also notable in comparison to prior research. This elevated mortality rate may reflect an increased burden of comorbidities in HIV patients. Further research is required to reveal if ART therapy reduces risk of poor outcomes, and if so, which regimen may confer protection against COVID-19.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86707232","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}
Pub Date : 2021-05-01DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1986
Lisa N Glass, Pulmonary Disease, Sandrine Hanna, John P Lichtenberger, Ivana Milojevic, J. Ahari
Organizing pneumonia is a process of lung parenchymal injury caused by multiple etiologies. Although organizing pneumonia may be an idiopathic process, it usually occurs secondary to infection, aspiration, autoimmune disease, and after organ transplantation or radiation. We present a case of organizing pneumona after confirmed SARS-CoV-2 (COVID-19) infection manifesting as chronic cough. Keywords: Organizing pneumonia; COVID-19; Post-viral syndrome; Chronic cough.
{"title":"A Continuous Cough After COVID-19","authors":"Lisa N Glass, Pulmonary Disease, Sandrine Hanna, John P Lichtenberger, Ivana Milojevic, J. Ahari","doi":"10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1986","DOIUrl":"https://doi.org/10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A1986","url":null,"abstract":"Organizing pneumonia is a process of lung parenchymal injury caused by multiple etiologies. Although organizing pneumonia may be an idiopathic process, it usually occurs secondary to infection, aspiration, autoimmune disease, and after organ transplantation or radiation. We present a case of organizing pneumona after confirmed SARS-CoV-2 (COVID-19) infection manifesting as chronic cough. Keywords: Organizing pneumonia; COVID-19; Post-viral syndrome; Chronic cough.","PeriodicalId":23189,"journal":{"name":"TP31. TP031 INTERESTING CASES ASSOCIATED WITH SARS-COV-2 INFECTION","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79019275","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}
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