Ghenu Maria Iuliana, Manea Maria Mirabela, Timofte Delia, Balcangiu-Stroescu Andra-Elena, Ionescu Dorin, Tulin Raluca, Ciornei Mariana Cătălina, Dragoş Dorin
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania [Faculty of Medicine, Medical Semiology Department (MIG, DI, DD), Faculty of Medicine, Functional Sciences Department, Physiology Discipline (MCC), Faculty of Medicine, Clinical Neurosciences Department (MM), Faculty of Dental Medicine, Physiology Discipline (AEBS), Faculty of Medicine, Embryology Department (RT)].
1st Internal Medicine Clinic, University Emergency Hospital Bucharest, Bucharest, Romania.
Clin Med Insights Case Rep. 2023 May 20;16:11795476231175644. doi: 10.1177/11795476231175644. eCollection 2023.
It is already known that Coronavirus disease 2019 (COVID-19) may lead to various degrees and forms of lung parenchyma damage, but some cases take a strikingly severe course that is difficult to manage. We report the case of a 62-year old male, non-obese, non-smoker, and non-diabetic, who presented with fever, chills, and shortness of breath. The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed by real-time Polymerase Chain Reaction. Although the patient had been vaccinated with 2 doses of Pfizer-BioNTech COVID-19 vaccine 7 months earlier and had no risk factors for a severe outcome, serial computed tomography (CT) scan revealed lung involvement progressively extending from an initial 30% to 40% to almost 100% 2.5 months later. The spectrum of lung lesions included at first only ground-glass opacities and some tiny emphysema bullae, but later also bronchiectasis, pulmonary fibrosis, and large emphysema bullae as post-COVID-19 pulmonary sequelae. For fear of severe evolution of superimposed bacterial infection (Clostridoides difficile enterocolits and possibly bacterial pneumonia) the administration of corticosteroids was intermittent. Massive right pneumothorax secondary to bulla rupture, possibly favored by the indispensable high flow oxygen therapy, led to respiratory failure compounded by hemodynamic instability, and ultimately to the patient's final demise. COVID-19 pneumonia may cause severe lung parenchyma damage which requires long-term supplemental oxygen therapy. Beneficial or even lifesaving as it might be, high flow oxygen therapy may nonetheless have deleterious effects too, including the development of bullae that may rupture engendering pneumothorax. Corticosteroid treatment should probably be pursued despite superimposed bacterial infection to limit the viral induced damage to lung parenchyma.
已知2019冠状病毒病（COVID-19）可能导致不同程度和形式的肺实质损伤，但有些病例病情极为严重，难以处理。我们报告一例62岁男性病例，该患者非肥胖、不吸烟、无糖尿病，表现为发热、寒战和呼吸急促。通过实时聚合酶链反应诊断为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染。尽管该患者在7个月前已接种2剂辉瑞-生物科技公司的COVID-19疫苗，且没有严重预后的风险因素，但连续计算机断层扫描（CT）显示，肺部受累范围在2.5个月后从最初的30%至40%逐渐扩大至几乎100%。肺部病变起初仅包括磨玻璃影和一些微小的肺气肿大疱，但后来还出现了支气管扩张、肺纤维化以及作为COVID-19后肺部后遗症的大肺气肿大疱。由于担心叠加细菌感染（艰难梭菌小肠结肠炎以及可能的细菌性肺炎）的严重进展，糖皮质激素的使用是间歇性的。大疱破裂继发的大量右侧气胸，可能因不可或缺的高流量氧疗而加重，导致呼吸衰竭并伴有血流动力学不稳定，最终导致患者死亡。COVID-19肺炎可能导致严重的肺实质损伤，需要长期补充氧气治疗。尽管高流量氧疗可能有益甚至挽救生命，但它也可能有有害影响，包括大疱形成并可能破裂导致气胸。尽管存在叠加细菌感染，仍可能应进行糖皮质激素治疗，以限制病毒对肺实质的损伤。
