DOI: 10.12890/2022_003385
Severe Pneumonia Caused by SARS-CoV-2: A Novel Cause of Platypnoea-Orthodeoxia Syndrome
Authors
jpabreufernandes@gmail.com
Keywords
Platypnoea-orthodeoxia syndrome, COVID-19, severe pneumonia, rehabilitationAbstract
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.
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.