Spontaneous massive hemothorax as a complication of necrotizing pneumonia in a patient with severe acute respiratory syndrome coronavirus 2 induced acute respiratory distress syndrome: a case report.

BACKGROUND: We present an unusual bleeding complication in a patient with severe acute respiratory distress syndrome in coronavirus disease 2019. CASE PRESENTATION: The patient, a 63-year-old Caucasian man, received venovenous extracorporeal membrane oxygenation support after rapid deterioration of lung function on day 6 after admission to hospital. After initial stabilization on lung protective ventilation and prone positioning, he started to develop mild bleeding complications until he went into occult profound hemorrhagic shock. Causative was a massive hemothorax of the right hemithorax with mediastinal shifting due to spontaneous bleeding from a pulmonal artery in a heavily remodeled right inferior lobe. Histopathological examination of the resected tissue showed signs of an organizing fibrinous pneumonia with focal parenchyma necrosis. After surviving a massive bleeding event caused by necrotizing pneumonia, the patient made a swift recovery and was discharged to rehabilitation 31 days after initial hospital admission. CONCLUSIONS: The combination of severely elevated inflammatory markers and pulmonary hemorrhage should arouse suspicion of necrotizing pneumonia. In necrotizing pneumonia, the possibility of severe intrathoracic bleeding complications should be kept in mind if it comes to sudden deterioration of the patient.

[Necrotizing pneumonia associated with influenza A H1N1 infection in a child with mucopolysaccharidosis type II. Case report]. / Neumonía necrotizante asociada a infección por influenza A H1N1 en un niño con mucopolisacaridosis tipo II: Caso clínico.

Mucopolysaccharidosis type II (MPS II) is an X-linked recessive disorder characterized by a deficiency of the enzyme iduronate-2-sulfatase leading to a multisystem involvement by tissue accumulation of glycosaminoglycans heparan and dermatan sulfate. We report a case of a 9-year-old boy diagnosed with mucopolysaccharidosis type II at 4 years of age, classified as severe variant. He presented necrotizing pneumonia associated with influenza A H1N1 infection, requiring mechanical ventilation for 1 month and 10 days. This case emphasizes the importance of healthcare workers to be aware of potentially lethal complications in patients with MPS II, such as influenza A H1N1 infection, which in turn may be associated with necrotizing pneumonia.