Severe Pneumonia Caused by SARS-CoV-2: A Novel Cause of Platypnoea-Orthodeoxia Syndrome
  • José Pedro Abreu Fernandes
    Serviço de Medicina Interna, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal https://orcid.org/0000-0003-3616-9417
  • João Santos Faria
    Serviço de Medicina Física e Reabilitação, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Andreia Fernandes
    Serviço de Endocrinologia, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, Portugal
  • Ana Rita Ramalho
    Serviço de Medicina Interna, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  • Adriana Girão
    Serviço de Medicina Interna, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  • Maja Petrova
    Serviço de Medicina Interna, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal

Keywords

Platypnoea-orthodeoxia syndrome, COVID-19, severe pneumonia, rehabilitation

Abstract

Platypnoea-orthodeoxia syndrome (POS) is a condition characterized by dyspnoea and hypoxaemia while sitting or standing, which improves during decubitus. It is usually caused by intracardiac right-to-left shunting through a patent foramen ovale but may also occur due to pulmonary ventilation-perfusion mismatch of other aetiologies. A new cause of POS was recently described: SARS-CoV-2 pneumonia. We report the case of a 62-year-old man admitted for SARS-CoV-2 pneumonia with respiratory failure. Chest computed tomography angiography showed pulmonary thromboembolism and parenchymal lung changes compatible with COVID-19. He had worsening dyspnoea in a sitting position, relieved by assuming the dorsal position. He was diagnosed with POS after other causes were excluded. POS is an underdiagnosed complication of COVID-19 and is manageable with respiratory rehabilitation.

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References

  • Agrawal A, Palkar A, Talwar A. The multiple dimensions of platypnea-orthodeoxia syndrome: a review. Respir Med 2017;129:31–38. doi: 10.1016/j.rmed.2017.05.016.
  • De Vecchis R, Baldi C, Ariano C, Giasi A, Cioppa C. Platypnea-orthodeoxia syndrome: orthostatic dyspnea and possible pathophysiological substrates. Herz 2017;42(4):384–389. doi: 10.1007/s00059-016-4479-4.
  • De Vecchis R, Baldi C, Ariano C. Platypnea-orthodeoxia syndrome: multiple pathophysiological interpretations of a clinical picture primarily consisting of orthostatic dyspnea. J Clin Med 2016;5(10):85. doi: 10.3390/jcm5100085.
  • Tan GP, Ho S, Fan BE, Chotirmall SH, Tan CH, Lew SJW, et al. Reversible platypnea-orthodeoxia in COVID-19 acute respiratory distress syndrome survivors.Respir Physiol Neurobiol 2020;282:103515. doi: 10.1016/j.resp.2020.103515.
  • Longo C, Ruffini L, Zanoni N, Longo F, Accogli R, Graziani T, et al. Platypnea-orthodeoxia after fibrotic evolution of SARS-CoV-2 interstitial pneumonia. A case report. Acta Biomed 2020; 91(3):ahead of print. doi: 10.23750/abm.v91i3.10386.
  • Souza T, Dantas F, Loureiro C, Serra J, Marinho J. Ampliando o diagnóstico diferencial: infecção pelo SARS-CoV-2 associada a pneumomediastino e síndrome platipneia-ortodeoxia. Revista Científica Hospital Santa Izabel 2021;4:159–163. doi: 10.35753/rchsi.v4i3-4.185.
  • Tham SL, Ong PL, Lee AJY, Tay MRJ. Rehabilitation of patients with platypnea-orthodeoxia syndrome in COVID-19 pneumonia: two case reports. J Rehabil Med Clin Commun 2020;3:1000044. doi: 10.2340/20030711-1000044.
  • Tedjasaputra V, Sá RC, Anderson KM, Prisk GK, Hopkins SR. Heavy upright exercise increases ventilation-perfusion mismatch in the basal lung: indirect evidence for interstitial pulmonary edema. J Appl Physiol (1985) 2019;127(2):473–481. doi: 10.1152/japplphysiol.00056.2019.
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    Published: 2022-08-19
    Issue: 2022: Vol 9 No 8 (view)


    How to cite:
    1.
    Abreu Fernandes JP, Santos Faria J, Fernandes A, Ramalho AR, Girão A, Petrova M. Severe Pneumonia Caused by SARS-CoV-2: A Novel Cause of Platypnoea-Orthodeoxia Syndrome. EJCRIM 2022;9 doi:10.12890/2022_003385.