COVID-19 pneumonia with ARDS and secondary haemophagocytic lymphohistiocytosis: a case report

Yıl 2021, Cilt: 7 Sayı: 5, 533 - 540, 04.09.2021

Hasan Ölmez Mustafa Tosun Edhem Ünver , Nurten Arslan Işık

https://doi.org/10.18621/eurj.783155

Öz

Although most people with COVID-19 have mild to moderate symptoms; some people may experience worsened symptoms, such as pneumonia, acute respiratory distress syndrome (ARDS) and and respiratory failure. Here we reported a case of COVID-19 pneumonia with ARDS and secondary haemophagocytic lymphohistiocytosis (sHLH). A 44-year-old man presented to the emergency department with a history of cough, fever, sore throat, and muscle ache. The patient transferred to Chest Diseases Department, with a diagnosis of COVID-19 pneumonia. Oseltamivir, hydroxychloroquine, azithromycin, low molecular weight heparin (LMWH) and favipravir added to the treatment. Tocilizumab started after endotracheal intubation. In general, we saw improvement in respiratory values and vital signs. Administration of LMWH to the patient may have prevented the development of coagulopathy. In conclusion, using HFO system and using low tidal volume according to ARDS net protocol, using optimal PEEP/FiO2 ratio, paying attention to keeping driver pressures low may be beneficial for the clinical improvement of the disease.

Anahtar Kelimeler

COVID-19, respiratory failure, pneumonia, ARDS, tocilizumab

Kaynakça

• 1. WHO. Novel Coronavirus (‎ 2019-nCoV)‎: situation report, 3 [Internet]. 2020 [cited 2020 May 3]. Available from: https://apps.who.int/iris/bitstream/handle/10665/330762/nCoVsitrep23Jan2020-eng.pdf
• 2. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
• 3. Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis 2020;71:769-77.
• 4. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470-3.
• 5. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a Report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.
• 6. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-43.
• 7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
• 8. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
• 9. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020;323:1843-4.
• 10. Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020;295:22-3.
• 11. Xie X, Zhong Z, Zhao W, Zheng C, Wang F, Liu J. Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. Radiology 2020;296:E41-5.
• 12. Kong W, Agarwal PP. Chest imaging appearance of COVID-19 infection. Radiol Cardiothorac Imaging 2020;2:e200028.
• 13. Pan Y, Guan H. Imaging changes in patients with 2019-nCov. Eur Radiol 2020;30:3612-3.
• 14. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020;30:4381-9.
• 15. Wu Y, Xie Y, Wang X. Longitudinal CT findings in COVID-19 pneumonia: case presenting organizing pneumonia pattern. Radiol Cardiothorac Imaging 2020;2:e200031.
• 16. Li X, Zeng X, Liu B, Yu Y. COVID-19 infection presenting with CT halo sign. Radiol Cardiothorac Imaging 2020;2:e200026.
• 17. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Nat Sci Rev 2020;7:998-1002.
• 18. Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J 2005;2:69.
• 19. Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020;14:72-3.
• 20. Ding Q, Lu P, Fan Y, Xia Y, Liu M. The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China. J Med Virol 2020;92:1549-1555.
• 21. Kanoh S, Rubin BK. Mechanisms of action and clinical application of macrolides as immunomodulatory medications. Clin Microbiol Rev 2010;23:590-615.
• 22. Tran DH, Sugamata R, Hirose T, Suzuli T, Noguchi Y, Sugawara A, et al. Azithromycin, a 15-membered macrolide antibiotic, inhibits influenza A (H1N1) pdm09 virus infection by interfering with virus internalization process. J Antibiot (Tokyo) 2019;72:759-68.
• 23. Levi M, van der Poll T. Coagulation and sepsis. Thromb Res 2017;149:38-44.
• 24. Gupta N, Zhao YY, Evans CE. The stimulation of thrombosis by hypoxia. Thromb Res 2019;181:77-83.
• 25. Luo WR, Yu H, Gou JZ, Li XX, Sun Y, Li JX, et al. Histopathologic findings in the explant lungs of a patient with COVID-19 treated with bilateral orthotopic lung transplant. Transplantation 2020;104:e329-31.
• 26. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020;18:1094-9.
• 27. De Clercq E. New nucleoside analogues for the treatment of hemorrhagic fever virus infections. Chem Asian J 2019;14:3962-8.
• 28. Chen C, Zhang Y, Huang J, Yin P, Cheng Z, Wu J, et al. Favipiravir versus arbidol for COVID-19: a randomized clinical trial. medrxiv.org [Internet]. [cited 2020 May 4]; Available from: https://doi.org/10.1101/2020.03.17.20037432.
• 29. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307:2526-33.
• 30. Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. Covid-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Respir Crit Care Med 2020;201:1299-300.
• 31. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med 2020;46:1099-102.