Unilateral Ground-glass Opacities Research Articles

Clinico-epidemiological profile of non-survivors of COVID-19 during the last two waves in a tertiary care hospital of North India: A retrospective descriptive study

Background: SARS-CoV-causing COVID-19 resulted in mortality, and the clinic-epidemiological profile at the time of admission of patients who died later could provide an insight into pathophysiological consequences due to infection. Method: Retrospective observational study of 64 RTPCR-confirmed COVID-19 non-survivors was conducted from April - June 2021 and January February 2022. Data were analyzed, and a P value<0.05 was taken as significant. Results: 60.94% and 39.06 % were males and females, and 26.57% & 73.43 % of patients had moderate and severe disease, respectively. Fever, cough, and dyspnea were the most common presenting symptoms. 78.12% and 21.88% had pre-existing (diabetes and hypertension were most common) and no co-morbidities, respectively. 65.62 & 17.19 % of patients had bilateral and unilateral ground glass opacities, respectively. Thrombocytopenia, lymphopenia, neutrophilia, elevated monocytes, and neutrophil-lymphocyte ratio (NLR) of 7.52 were hematological findings. D dimer was elevated. ABG showed low PaO2 and SPO2 %. ALT and AST were elevated. Tachycardia was also present. Compared to the first wave, no significant association of gender with severity was found. However, the percentage of male patients was higher. The association of the duration of stay and co-morbidity with disease severity was significant in both the first and subsequent waves of COVID-19. Conclusion: Co-morbidity, disease severity, and radiological lung opacities play a role in the outcome of COVID-19. The associated findings are hematological, renal, liver, cardiovascular, and arterial blood gas derangements.

REFRACTORY SIROLIMUS-INDUCED PULMONARY ALVEOLAR PROTEINOSIS IN A PATIENT WITH LUNG TRANSPLANT

SESSION TITLE: Fellows Transplantation Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a rare disease with accumulation of proteins and lipids within the alveolar macrophages with considerable morbidity and mortality [1]. PAP etiologies include a primary autoimmune process due to anti-granulocyte macrophage colony stimulating factor (GM-CSF) antibodies while secondary causes include medications, infection, toxic inhalations, or hematological disorders [1]. Sirolimus, an immunosuppressant used in organ transplantation, is a rare cause of reversible PAP [2-6]. We present a patient who worsened despite discontinuation of sirolimus, regional lung lavage and inhaled GM-CSF. CASE PRESENTATION: A 57 year old female underwent bilateral lung transplant for idiopathic pulmonary fibrosis, complicated by acute rejection, bilateral pulmonary embolism, pulmonary artery stenosis requiring stenting, and bilateral airway anastomotic stenosis requiring a left mainstem stent. She presented with hypoxia five years post-transplant on sirolimus and prednisone. Chest CT demonstrated new unilateral ground glass opacities with bilateral septal thickening. Bronchoalveolar lavage (BAL) had milky fluid return, concerning for PAP. Sirolimus was discontinued and cyclosporine started. A segmental large volume BAL of the right upper lobe failed to improve hypoxia or shortness of breath and whole lung lavage was impractical due to bilateral anastomotic stenosis. She had resultant renal failure secondary to cyclosporine while off sirolimus for 3 months. Oxygen requirement and imaging failed to improve. Her anti-GM-CSF antibody test was negative and other causes of secondary PAP were ruled out. Salvage inhaled GM-CSF (sargramostim) was begun for progressive hypoxemic respiratory failure. VV-ECMO and whole lung lavage were offered but the patient declined. After four cycles of inhaled GM-CSF, her condition deteriorated and she passed away on POD 2492. Autopsy confirmed severe PAP. DISCUSSION: Sirolimus is a rare cause of secondary PAP. Typically sirolimus-induced PAP improves with medication discontinuation and potentially whole lung lavage. In this case, whole lung lavage was deemed impractical due to airway anatomy. She did not improve with sirolimus discontinuation or inhaled GM-CSF. Further research into the mechanism related to sirolimus induced PAP is necessary as this medication is widely used in complex patients with solid organ transplants. CONCLUSIONS: Sirolimus is implicated in drug induced PAP with expected reversibility when the medication is discontinued. This refractory case highlights the need for better understanding and treatment options in complex solid organ transplant patients. Reference #1: 1.Borie, R., et al., Pulmonary alveolar proteinosis. European Respiratory Review, 2011. 20(120): p. 98-107. 2.Mattewal, A.S., et al., Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus in lung transplant patients. Chest, 2009. 136(4): p. 23S. 3.Pedroso, S.L., et al., Pulmonary alveolar proteinosis – a rare pulmonary toxicity of sirolimus. Transplant International, 2007. 20(3): p. 291-296. 4.Kadikoy, H., et al., Pulmonary alveolar proteinosis in a kidney transplant: a rare complication of sirolimus. Nephrology Dialysis Transplantation, 2010. 25(8): p. 2795-2798. 5.Garrean, S., et al., Sirolimus-associated interstitial pneumonitis in solid organ transplant recipients. Clinical transplantation, 2005. 19(5): p. 698-703. 6.Dhawan, K., A. Pope-Harman, and N. Sood, PULMONARY ALVEOLAR PROTEINOSIS SECONDARY TO SIROLIMUS IN A RENAL TRANSPLANT PATIENT. CHEST, 2009. 136(4): p. 34S. DISCLOSURES: No relevant relationships by Brian Boer, source=Web Response no disclosure on file for Heather Strah; No relevant relationships by Grant Turner, source=Web Response No relevant relationships by Navin Victor, source=Web Response

High-Resolution Computed Tomography Manifestations of 5 Pediatric Patients With 2019 Novel Coronavirus

We present clinical and chest computed tomography (CT) features of 5 cases of pediatric patients with 2019 novel coronavirus. Two patients had fever and dry cough, whereas the rest of 3 patients were asymptomatic. Three patients had unilateral ground glass opacities with or without consolidation in the subpleural region on high-resolution chest CT, 1 patient had bilateral ground glass opacities, and 1 patient was negative for CT. We note that up to 66.7% asymptomatic patients had pulmonary lesions, so the asymptomatic children with Wuhan contact are recommended to do a 2019 novel coronavirus real-time fluorescence polymerase chain reaction screening. Unlike adult patients, only a small amount of patients had multilobes affected, so we speculate that the pediatric patients generally have milder CT findings than adults.