Department of Internal Medicine, Division of Hematology, Rheumatology, and Respiratory Medicine, Faculty of Medicine, Kagawa University, Miki, Kagawa, Japan.
Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Miki, Kagawa, Japan.
Am J Case Rep. 2023 May 24;24:e939251. doi: 10.12659/AJCR.939251.
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.
COVID-19 相关肺曲霉病（CAPA）、急性呼吸窘迫综合征（ARDS）、肺血栓栓塞症（PTE）和气胸是重症 COVID-19 患者的并发症。
一名 64 岁的日本男性被诊断患有 COVID-19。他既往患有未控制的糖尿病。他没有接种过 COVID-19 疫苗。尽管给予吸氧、瑞德西韦、地塞米松（每天 6.6 毫克）和巴瑞替尼（每天 4 毫克，共 12 天）治疗，但病情仍在进展。患者接受机械通气支持。将地塞米松换为甲泼尼龙（每天 1000 毫克，连用 3 天，然后每 3 天减半），并开始静脉用肝素。由于在气管内痰中检测到烟曲霉，开始使用伏立康唑（第 1 天 800 毫克，然后每天 400 毫克，连用 14 天）。然而，他最终因呼吸衰竭而死亡。尸检的病理发现：（1）肺部广泛区域弥漫性肺泡损伤，与 COVID-19 肺炎所致的 ARDS 一致，（2）外周肺小动脉中的 PTE，（3）CAPA，以及（4）由 CAPA 引起的气胸。这些情况均处于活动状态，表明治疗不足。
尽管对每种疾病均进行了大量治疗，但对重症 COVID-19 患者的尸检显示 ARDS、PTE 和 CAPA 存在活跃病变。CAPA 可导致气胸。由于这些治疗可能会引发拮抗的生物学作用，因此同时改善这些情况并不容易。为预防重症 COVID-19，降低危险因素（如接种疫苗和适当控制血糖）非常重要。
