RESUMO
INTRODUCTION: Antineutrophil cytoplasmic autoantibody-associated vasculitis is an immune-mediated necrotizing vasculitis, affecting small- and medium-sized vessels. CASE REPORT: A 22-year-old female patient with free medical history presented with life-threatening pulmonary hemorrhage due to antineutrophil cytoplasmic autoantibody-associated vasculitis, temporarily associated with influenza A H1N1 infection. Due to rapidly worsening respiratory failure, despite conventional management, veno-venous peripheral extracorporeal membrane oxygenation was initiated and continued for 26 days, with subsequent renal replacement therapy. DISCUSSION: We present a case of severe antineutrophil cytoplasmic autoantibody-associated pulmonary vasculitis, managed with veno-venous extracorporeal membrane oxygenation at the initial phase. Despite the significant challenges raised with the use of extracorporeal membrane oxygenation in pulmonary hemorrhage cases, extracorporeal membrane oxygenation may have a significant impact on outcome in this setting, by providing adequate time for a successful immunosuppressive treatment.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/metabolismo , Oxigenação por Membrana Extracorpórea/métodos , Adulto , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1 , Adulto JovemAssuntos
Atenção à Saúde/organização & administração , Recessão Econômica , Departamentos Hospitalares/organização & administração , Neoplasias Pulmonares/terapia , Área Programática de Saúde , Grécia/epidemiologia , Fidelidade a Diretrizes , Gastos em Saúde , Hospitais Universitários , Humanos , Neoplasias Pulmonares/epidemiologia , Equipe de Assistência ao Paciente , Derrame Pleural Maligno/epidemiologia , Derrame Pleural Maligno/terapia , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Cirurgia Torácica Vídeoassistida , ToracoscopiaRESUMO
In COVID-19 related end stage lung disease, there are two distinct phenotypes. The first phenotype is the COVID-19 related acute respiratory distress syndrome (CARDS) showing a classical histopathological pattern of fibrotic diffuse alveolar damage (DAD). The second phenotype is the post-COVID pulmonary fibrosis (PCPF), in which the diagnosis is based on the combined clinical, radiological and (if available) pathological information. Both phenotypes have different clinical features, risk factors, biomarkers and pathophysiology. The exact prognosis in these two phenotypes as well as optimal treatment needs further studies.Key messagesTwo different phenotypes exist for COVID-19 related pulmonary fibrosis. The CARDS phenotype has a worse prognosis compared to the PCPF phenotype, which requires longer-term follow-up and evolves without ARDS picture. The best treatment options for the two different phenotypes, such as anti-fibrotic drugs or lung transplantation, still needs to be defined in future studies.
Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Fenótipo , SARS-CoV-2RESUMO
Can you diagnose this man presenting with chronic cough and progressive shortness of breath on exertion and fatigue developing over several months? http://ow.ly/ekZd30k8VcM.