Vol 4-2 Case Report

COVID-19 Pneumonia in Bilateral Lung Transplant Recipient: Case Report

Juan Pablo Reig Mezquida1*, Alilis Fontana Bellorín2, Alberto García Ortega3, Gabriel Anguera de Francisco1

1Lung Transplant Unit, Hospital Universitario la Fe, Valencia, Spain

2Department of Thoracic Surgery, Hospital Universitario la Fe, Valencia, Spain

3Department of Pulmonology, Hospital Universitario la Fe, Instituto de Investigación Sanitaria “La Fe”. Valencia, Spain

The clinical course of Coronavirus disease 2019 (covid-19) in lung transplant recipients remains unknown. We present the fatal clinical course of a 63-year old double lung transplant recipient with severe Covid-19 pneumonia. She had stable graft function before Covid-19 infection. Despite all the supportive care and treatment graft injury progressed, causing patient death. Therefore, the prognosis in lung transplant recipients with Covid-19 infection is not optimistic.

DOI: 10.29245/2689-999X/2020/2.1164 View / Download Pdf
Vol 4-2 Case Report

Barotrauma in COVID-19 Patients

Mohammad Abdallat1*, Mazhar Khalil1, Ghayth Al-Awwa1, Ravi Kothuru2, Charles La Punzina2

1Department of Surgery, Brookdale University Hospital and Medical Center, USA

2Cardiothoracic Surgery, Brookdale University Hospital and Medical Center, USA

Background: This case series assessed the clinical outcomes and characteristics of barotrauma in COVID19 patients.

Methods: The electronic medical records of all patients admitted with confirmed COVID 19 infection who eventually developed barotrauma between March 17th, 2020 and April 17th, 2020 were reviewed, information about patient characteristics, pattern and characteristic of barotrauma were analyzed and reported in a descriptive manner.

Results: 25 patients developed evidence of barotrauma on Chest Xray or Computed tomography (CT) with a mean age of 60.1 at the time of diagnosis, 12 (48%) developed severe ARDS with PaO2/FiO2 ratio of <100. 14 (56%) patients developed pneumothorax, 7 had evidence of subcutaneous emphysema and 6 developed pneumomediastinum. More barotrauma occured in the first day of ventilation than any other day, the median time between mechanical ventilation and development of barotrauma is 3.5 days.

Conclusion: Barotrauma in COVID 19 is associated with an increased mortality (64%) which may reflect worse acute lung injury in these cases. The median time to develop barotrauma in these patients is similar to the one described in ARDs literature.

DOI: 10.29245/2689-999X/2020/2.1163 View / Download Pdf
Vol 4-2 Case Report

Disseminated BCG-osis and the Importance of Performing Post-Mortem Examinations

Paul Andrew Lilburn1,2*, Patrick Bazin2, Alexander Beveridge2, Emma Goeman3, Hazel Goldberg1,3,4,5

1Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia

2St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia

3Royal Prince Alfred, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia

4Sydney Hospital, 8 Macquarie Street, Sydney, NSW, 2000, Australia

5St George Hospital, Kogarah, NSW 2017, Australia

Bacillus Calmette-Guerin (BCG) is a live-attenuated strain of Mycobacterium bovis (M bovis), originally developed as a vaccine against tuberculosis. It is also used in the treatment of bladder cancer. We present a case of disseminated BCG-osis which was only discovered at post-mortem. An 89-year-old male was admitted to a tertiary referral centre in inner Sydney in December 2015 with fevers, night sweats, exertional dyspnoea and 8 kg weight loss. The patient developed progressive type 1 respiratory failure requiring non-invasive positive pressure ventilation and treatment for heart failure, but he died eleven days into his admission. On microbiological testing Mycobacterium. tuberculosis complex (MTBC) DNA was detected in lung tissue, by polymerase chain reaction (PCR), using the Xpert® MTB/RIF (Cepheid) platform, the day after the patient’s death. Later mycobacterial culture and genomic deletion analysis identified the specific organism as M bovis. This report describes an unusual presentation of systemic BCG-osis appearing more than three years after the last BCG instillation. This reinforces the fact that BCG instillation of the bladder for transitional cell carcinoma poses a potential risk of systemic spread even years after.

DOI: 10.29245/2689-999X/2020/2.1161 View / Download Pdf