Filippini Alida, Bnà Claudio, Bellosta Raffaello, Bazzani Roberto, Luzzani Luca, Pegorer Matteo Alberto, Zandalasini Matteo, Baldon Michela, Codazzi Manuela, Sabatini Tony
Department of Internal Medicine, Gastroenterology and Endoscopy. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy.
Department of Radiology. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy.
Respir Med Case Rep. 2021;32:101358. doi: 10.1016/j.rmcr.2021.101358. Epub 2021 Jan 30.
Pulmonary infection of 2019-nCoV can frequently induce acute respiratory distress syndrome (ARDS) with partial pressure of arterial oxygen/fraction of inspired oxygen ratio (pO2/FiO2) of less than 300 mmHg. Moreover, it can be complicated with cardiac injury or arrhythmia, microvascular and large-vessel thrombosis. We describe a case of a patient with COVID19-ARDS and concomitant critical ischemia of the limbs. Iloprost treatment, an analogue of a prostacyclin PGI2, was started for residual left forefoot ischemia after surgical thromboembolectomy. Unexpectedly, we documented improvement of respiratory performance and lung high resolution computed tomography (HRCT) showed significant regression of the diffuse pulmonary ground-glass opacity. The hypothetical mechanism is that iloprost can enhance perfusion preferentially to well-ventilated lung regions, reduce pressures of peripheral pulmonary vessels and induce reduction of lung interstitial edema. In addition, iloprost antithrombotic effect, endothelial damage repairing and neo-angiogenesis activity could play a relevant role.
2019新型冠状病毒肺部感染常可诱发急性呼吸窘迫综合征（ARDS），动脉血氧分压/吸入氧分数比（pO2/FiO2）低于300 mmHg。此外，还可能并发心脏损伤或心律失常、微血管和大血管血栓形成。我们报告一例新型冠状病毒肺炎相关性ARDS并伴有肢体严重缺血的患者。在外科血栓切除术治疗残留的左前足缺血后，开始使用依洛前列素治疗，它是前列环素PGI2的类似物。出乎意料的是，我们记录到患者呼吸功能有所改善，肺部高分辨率计算机断层扫描（HRCT）显示弥漫性肺磨玻璃影明显消退。推测其机制是依洛前列素可优先增强通气良好肺区域的灌注，降低外周肺血管压力，并促使肺间质水肿减轻。此外，依洛前列素的抗血栓作用、修复内皮损伤及促血管新生活性可能也发挥了相关作用。
