Respiratory medicine case reports
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Respir Med Case Rep · Jan 2020
Case ReportsRecurrence of emphysema post-lung transplantation in a patient with alpha 1 antitrypsin deficiency (AATD).
The genetic disorder alpha 1 antitrypsin deficiency (AATD) results in reduced levels of alpha 1 antitrypsin (AAT) in the lung and an imbalance between AAT anti-protease activity and the activity of proteases that degrade elastin and connective tissues. This imbalance commonly leads to the excessive proteolysis of structural tissue of the alveoli, causing chronic obstructive pulmonary disease (COPD)/emphysema. ⋯ Recurrence of COPD/emphysema was observed in a patient with AATD 2 years after initial successful lung transplantation and cessation of AAT therapy who recommenced smoking after no signs of disease at the 1-year assessment. This case demonstrates that smoking cessation is critical in patients with AATD, even after lung transplant, and it highlights that patients with AATD may benefit from AAT therapy post-lung transplant.
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Respir Med Case Rep · Jan 2020
Case ReportsSuccessful recovery from COVID-19 pneumonia after receiving baricitinib, tocilizumab, and remdesivir. A case report: Review of treatments and clinical role of computed tomography analysis.
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic, threatening global public health. In the current paper, we describe our successful treatment of one COVID-19 pneumonia patient case with high mortality risk factors. Our experience underlines the importance of the use of a multidisciplinary therapeutic approach in order to achieve a favorable clinical outcome. Further, enhancing the capability of the COVID-19 diagnosis with the use of the chest imaging modalities is discussed.
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Respir Med Case Rep · Jan 2020
Case ReportsUse of esophageal balloon manometry in the management of pediatric acute respiratory distress syndrome.
There is paucity of literature regarding the use of esophageal balloon manometry in the management of Pediatric Acute Respiratory Distress Syndrome. We describe our first ever experience of successful usage of esophageal balloon pressure manometry in a child with acute respiratory distress syndrome. This is a six-year-old girl who presented with shortness of breath and fever and was found to be in severe acute respiratory distress syndrome due to septic shock secondary to group A streptococcus. ⋯ Esophageal balloon manometry guided positive end-expiratory pressure for 103 out of 155 hours of ventilation with no obvious sequelae. Our case shows the feasibility of transpulmonary pressure measurements in pediatric patients. This practice may be useful to optimize management in pediatric acute respiratory distress syndrome to improve outcomes.
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Respir Med Case Rep · Jan 2020
Case ReportsSARS-CoV2 induced pulmonary embolism and complications from anticoagulation.
Coronavirus disease (COVID-19) pandemic has rapidly spread around the world. As new complications associated with the virus become more apparent, concerns in the medical community continue to grow. One of the more commonly encountered and more troubling complications in critically ill patients has been hypercoagulable state and subsequent thrombotic events. ⋯ Literature review suggests that pulmonary clot burden in COVID-19 patients could be due to pulmonary thrombus rather than pulmonary embolism and is triggered by profuse vascular damage and severe inflammatory response. Literature review also proposes changes to the diagnostic work up in COVID-19 patients, such as earlier screening for pulmonary embolism in critically ill. In addition, rare and severe complications of current anticoagulation therapy is illustrated and discussed through one of the cases presented.
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Coronavirus disease 2019 (Covid-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It mainly affects the lungs and common symptoms are fever, cough and shortness of breath. Pneumothorax has been noted to complicate Covid-19 cases requiring hospital admission, however the exact incidence and risk factors are still unknown. ⋯ Our cases are a reminder that an acute deterioration with hypoxia in a Covid-19 patient could indicate a pneumothorax. Pneumothorax is one of the reported complications in Covid-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.