Roda Silvia, Ricciardi Alessandra, Maria Di Matteo Angela, Zecca Marco, Morbini Patrizia, Vecchia Marco, Chiara Pieri Teresa, Giordani Paola, Tavano Angelo, Bruno Raffaele
Department of Clinical, Surgical, Diagnostic and Pediatric sciences, University of Pavia, Italy.
Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Clin Infect Pract. 2022 Jul;15:100144. doi: 10.1016/j.clinpr.2022.100144. Epub 2022 Apr 26.
Sars-CoV2 can cause severe pneumonia and acute respiratory distress syndrome (ARDS). In COVID-19-associated respiratory failure, lung transplantation might be an option (Bharat A).
A previously healthy 63-year-old man with a nasopharyngeal swab positive for SarsCoV2 and radiological evidence of interstitial lung consolidations developed acute respiratory distress that required intubation and veno-venous extracorporeal membrane oxygenation support (VV ECMO). Because of no recovery of his lung function, he underwent a bilateral lung transplant. ICU stay was complicated by several episodes of bacterial superinfections and an increase of liver function tests (LFTs). Afterward, he faced a progressive clinical worsening associated to severe anemia, further rise of indices of cholestasis, hypertriglyceridemia and hyperferritinemia. Bone marrow smear showed a picture compatible with haemophagocytic lymphohistocytosis (HLH) and first and second line therapy were started. In addition, a transjugular hepatic biopsy was performed with histopathological evidence of portal and periportal fibrosis, compatible with Covid 19-related cholangiopathy. During the hospital stay, he developed several MDR opportunistic infections. The patient died few months later from multiorgan failure secondary to septic shock. A post-mortem confirmed a diagnosis of cholangiopathy, and medullary -haemophagocytosis.
Post Covid19 syndrome is a clinical entity that includes novel and old sequelae following recovery from Sars-CoV2 infections. Early identification of these diseases is crucial for adequate management and might influence the long term prognosis of these patients.
严重急性呼吸综合征冠状病毒2（Sars-CoV2）可导致严重肺炎和急性呼吸窘迫综合征（ARDS）。在新型冠状病毒肺炎（COVID-19）相关的呼吸衰竭中，肺移植可能是一种选择（巴拉特·A）。
一名63岁既往健康的男性，鼻咽拭子Sars-CoV2检测呈阳性，并有间质性肺实变的影像学证据，出现急性呼吸窘迫，需要插管和静脉-静脉体外膜肺氧合支持（VV ECMO）。由于肺功能未恢复，他接受了双侧肺移植。重症监护病房（ICU）住院期间出现了几次细菌二重感染，并伴有肝功能检查（LFTs）升高。此后，他出现了与严重贫血、胆汁淤积指标进一步升高、高甘油三酯血症和高铁蛋白血症相关的进行性临床恶化。骨髓涂片显示符合噬血细胞性淋巴组织细胞增生症（HLH）的表现，并开始了一线和二线治疗。此外，进行了经颈静脉肝活检，组织病理学证据显示门静脉和门周纤维化，符合COVID-19相关胆管病。住院期间，他发生了几次多重耐药机会性感染。患者数月后死于脓毒性休克继发的多器官功能衰竭。尸检确诊为胆管病和骨髓噬血细胞现象。
新型冠状病毒肺炎后综合征是一种临床实体，包括从Sars-CoV2感染恢复后的新的和旧的后遗症。早期识别这些疾病对于适当的管理至关重要，可能会影响这些患者的长期预后。
