tetano
Editor, Senior Moderator
Clin Med Insights Circ Respir Pulm Med
. 2022 Feb 4;16:11795484211073273.
doi: 10.1177/11795484211073273. eCollection 2022.
COVID-19 with Rapid Progression to Hypoxemia Likely due to Imbalance between Ventilation and Blood Flow: A Case Report
Nobuyuki Koriyama[SUP] 1 [/SUP], Akihiro Moriuchi[SUP] 1 [/SUP], Kensaku Higashi[SUP] 1 [/SUP], Tetsuro Kataoka[SUP] 1 [/SUP], Takuro Arimizu[SUP] 1 [/SUP], Go Takaguchi[SUP] 1 [/SUP], Hideki Matsuoka[SUP] 1 [/SUP], Maki Otsuka[SUP] 1 [/SUP]
Affiliations
Abstract
Background: In COVID-19 pneumonia, cases of severe hypoxemia in the early stage and cases of sudden deterioration in respiratory status due to silent hypoxia leading to death, have been reported.
Case summary: A 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful.
Conclusion: In COVID-19 patients with multiple comorbidities who have hypoxemia and coagulation abnormalities that are disproportionate to the severity of pneumonia on CT, it is important to commence antiviral and anticoagulant therapy as soon as possible, followed by use of a low dose of Dex.
Keywords: COVID-19; dexamethasone; hypoxic pulmonary vasoconstriction; nafamostat mesylate; pulmonary intravascular coagulopathy; remdesivir.
. 2022 Feb 4;16:11795484211073273.
doi: 10.1177/11795484211073273. eCollection 2022.
COVID-19 with Rapid Progression to Hypoxemia Likely due to Imbalance between Ventilation and Blood Flow: A Case Report
Nobuyuki Koriyama[SUP] 1 [/SUP], Akihiro Moriuchi[SUP] 1 [/SUP], Kensaku Higashi[SUP] 1 [/SUP], Tetsuro Kataoka[SUP] 1 [/SUP], Takuro Arimizu[SUP] 1 [/SUP], Go Takaguchi[SUP] 1 [/SUP], Hideki Matsuoka[SUP] 1 [/SUP], Maki Otsuka[SUP] 1 [/SUP]
Affiliations
- PMID: 35140541
- PMCID: PMC8819745
- DOI: 10.1177/11795484211073273
Abstract
Background: In COVID-19 pneumonia, cases of severe hypoxemia in the early stage and cases of sudden deterioration in respiratory status due to silent hypoxia leading to death, have been reported.
Case summary: A 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful.
Conclusion: In COVID-19 patients with multiple comorbidities who have hypoxemia and coagulation abnormalities that are disproportionate to the severity of pneumonia on CT, it is important to commence antiviral and anticoagulant therapy as soon as possible, followed by use of a low dose of Dex.
Keywords: COVID-19; dexamethasone; hypoxic pulmonary vasoconstriction; nafamostat mesylate; pulmonary intravascular coagulopathy; remdesivir.