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Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms

Patient: Male, 64-year-old Final Diagnosis: COVID-19 • pulmonary aspergillosis Symptoms: Cough • fever Clinical Procedure: — Specialty: Infectious Diseases • Pulmonology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA), acute respirat...

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Autores principales: Kanaji, Nobuhiro, Kimura, Nachino, Kondo, Akihiro, Watanabe, Naoki, Inoue, Takuya, Mizoguchi, Hitoshi, Komori, Yuta, Kawada, Kosuke, Kadowaki, Norimitsu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10226672/
https://www.ncbi.nlm.nih.gov/pubmed/37221822
http://dx.doi.org/10.12659/AJCR.939251
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author Kanaji, Nobuhiro
Kimura, Nachino
Kondo, Akihiro
Watanabe, Naoki
Inoue, Takuya
Mizoguchi, Hitoshi
Komori, Yuta
Kawada, Kosuke
Kadowaki, Norimitsu
author_facet Kanaji, Nobuhiro
Kimura, Nachino
Kondo, Akihiro
Watanabe, Naoki
Inoue, Takuya
Mizoguchi, Hitoshi
Komori, Yuta
Kawada, Kosuke
Kadowaki, Norimitsu
author_sort Kanaji, Nobuhiro
collection PubMed
description Patient: Male, 64-year-old Final Diagnosis: COVID-19 • pulmonary aspergillosis Symptoms: Cough • fever Clinical Procedure: — Specialty: Infectious Diseases • Pulmonology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA), acute respiratory distress syndrome (ARDS), pulmonary thromboembolism (PTE), and pneumothorax are complications in severe COVID-19 patients. CASE REPORT: A 64-year-old Japanese man was diagnosed with COVID-19. His past medical history included uncontrolled diabetes mellitus. He had no vaccination for COVID-19. Despite oxygen inhalation, remdesivir, dexamethasone (6.6 mg per day), and baricitinib (4 mg per day for 12 days), the disease progressed. The patient was supported with mechanical ventilation. Dexamethasone was switched to methylprednisolone (1000 mg per day for 3 days, and then reduced by half every 3 days), and intravenous heparin was initiated. Voriconazole (800 mg on the first day and then 400 mg per day for 14 days) was also started because Aspergillus fumigatus was detected in intratracheal sputum. However, he died of respiratory failure. Pathological findings of autopsy showed: (1) diffuse alveolar damage in a wide area of the lungs, which is consistent with ARDS due to COVID-19 pneumonia, (2) PTEs in peripheral pulmonary arteries, (3) CAPA, and (4) pneumothorax induced by CAPA. These conditions were all active states, suggesting that the treatments were insufficient. CONCLUSIONS: Autopsy revealed active findings of ARDS, PTEs, and CAPA in a severe COVID-19 patient despite heavy treatment for each condition. CAPA can be a cause of pneumothorax. It is not easy to improve these conditions simultaneously because their treatments can induce antagonizing biological actions. To prevent severe COVID-19, it is important to reduce risk factors, such as by vaccination and appropriate blood glucose control.
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spelling pubmed-102266722023-05-30 Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms Kanaji, Nobuhiro Kimura, Nachino Kondo, Akihiro Watanabe, Naoki Inoue, Takuya Mizoguchi, Hitoshi Komori, Yuta Kawada, Kosuke Kadowaki, Norimitsu Am J Case Rep Articles Patient: Male, 64-year-old Final Diagnosis: COVID-19 • pulmonary aspergillosis Symptoms: Cough • fever Clinical Procedure: — Specialty: Infectious Diseases • Pulmonology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA), acute respiratory distress syndrome (ARDS), pulmonary thromboembolism (PTE), and pneumothorax are complications in severe COVID-19 patients. CASE REPORT: A 64-year-old Japanese man was diagnosed with COVID-19. His past medical history included uncontrolled diabetes mellitus. He had no vaccination for COVID-19. Despite oxygen inhalation, remdesivir, dexamethasone (6.6 mg per day), and baricitinib (4 mg per day for 12 days), the disease progressed. The patient was supported with mechanical ventilation. Dexamethasone was switched to methylprednisolone (1000 mg per day for 3 days, and then reduced by half every 3 days), and intravenous heparin was initiated. Voriconazole (800 mg on the first day and then 400 mg per day for 14 days) was also started because Aspergillus fumigatus was detected in intratracheal sputum. However, he died of respiratory failure. Pathological findings of autopsy showed: (1) diffuse alveolar damage in a wide area of the lungs, which is consistent with ARDS due to COVID-19 pneumonia, (2) PTEs in peripheral pulmonary arteries, (3) CAPA, and (4) pneumothorax induced by CAPA. These conditions were all active states, suggesting that the treatments were insufficient. CONCLUSIONS: Autopsy revealed active findings of ARDS, PTEs, and CAPA in a severe COVID-19 patient despite heavy treatment for each condition. CAPA can be a cause of pneumothorax. It is not easy to improve these conditions simultaneously because their treatments can induce antagonizing biological actions. To prevent severe COVID-19, it is important to reduce risk factors, such as by vaccination and appropriate blood glucose control. International Scientific Literature, Inc. 2023-05-24 /pmc/articles/PMC10226672/ /pubmed/37221822 http://dx.doi.org/10.12659/AJCR.939251 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Kanaji, Nobuhiro
Kimura, Nachino
Kondo, Akihiro
Watanabe, Naoki
Inoue, Takuya
Mizoguchi, Hitoshi
Komori, Yuta
Kawada, Kosuke
Kadowaki, Norimitsu
Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms
title Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms
title_full Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms
title_fullStr Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms
title_full_unstemmed Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms
title_short Autopsy Findings of Severe COVID-19 Pneumonia Combined with Pulmonary Aspergillosis, Pneumothorax, and Pulmonary Thromboembolisms
title_sort autopsy findings of severe covid-19 pneumonia combined with pulmonary aspergillosis, pneumothorax, and pulmonary thromboembolisms
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10226672/
https://www.ncbi.nlm.nih.gov/pubmed/37221822
http://dx.doi.org/10.12659/AJCR.939251
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