tetano
Editor, Senior Moderator
Clin Infect Pract
. 2022 Jul;15:100144.
doi: 10.1016/j.clinpr.2022.100144. Epub 2022 Apr 26.
Post-acute coronavirus disease 2019 (COVID 19) syndrome: HLH and cholangiopathy in a lung transplant recipient
Silvia Roda[SUP] 1 2 [/SUP], Alessandra Ricciardi[SUP] 2 [/SUP], Angela Maria Di Matteo[SUP] 2 [/SUP], Marco Zecca[SUP] 3 [/SUP], Patrizia Morbini[SUP] 4 [/SUP], Marco Vecchia[SUP] 2 [/SUP], Teresa Chiara Pieri[SUP] 1 2 [/SUP], Paola Giordani[SUP] 1 2 [/SUP], Angelo Tavano[SUP] 1 2 [/SUP], Raffaele Bruno[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: 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).
Case report: 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 erythro-haemophagocytosis.
Conclusion: 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.
Keywords: Haemophagocytic lymphohistocytosis; Post COVID-19 Cholangiopathy; Post Covid19 syndrome; Sars-CoV2.
. 2022 Jul;15:100144.
doi: 10.1016/j.clinpr.2022.100144. Epub 2022 Apr 26.
Post-acute coronavirus disease 2019 (COVID 19) syndrome: HLH and cholangiopathy in a lung transplant recipient
Silvia Roda[SUP] 1 2 [/SUP], Alessandra Ricciardi[SUP] 2 [/SUP], Angela Maria Di Matteo[SUP] 2 [/SUP], Marco Zecca[SUP] 3 [/SUP], Patrizia Morbini[SUP] 4 [/SUP], Marco Vecchia[SUP] 2 [/SUP], Teresa Chiara Pieri[SUP] 1 2 [/SUP], Paola Giordani[SUP] 1 2 [/SUP], Angelo Tavano[SUP] 1 2 [/SUP], Raffaele Bruno[SUP] 1 2 [/SUP]
Affiliations
- PMID: 35498053
- PMCID: PMC9040417
- DOI: 10.1016/j.clinpr.2022.100144
Abstract
Background: 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).
Case report: 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 erythro-haemophagocytosis.
Conclusion: 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.
Keywords: Haemophagocytic lymphohistocytosis; Post COVID-19 Cholangiopathy; Post Covid19 syndrome; Sars-CoV2.