ABSTRACT
During the virtual European Respiratory Society Congress 2020, early career members summarised the sessions organised by the Respiratory Intensive Care Assembly. The topics covered included diagnostic strategies in patients admitted to the intensive care unit with acute respiratory failure, with a focus on patients with interstitial lung disease and for obvious reasons, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These sessions are summarised in this article, with take-home messages highlighted.
ABSTRACT
Eosinopenia was frequently encountered in patients with coronavirus disease 2019 (COVID-19). We describe a case of a 59-year-old man who was treated with high-dose corticosteroids and anti-interleukin 1 receptor antagonist therapy because of severe acute respiratory distress syndrome due to a so-called cytokine storm in COVID-19. He had chronic eosinophilia for many years due to an unknown Strongyloides stercoralis infection, proven by serology and a positive polymerase chain reaction test on a stool sample. COVID-19 led to a complete resolution of eosinophilia, even before immunosuppressive treatment was started. Eosinophilia returned after recovery from COVID-19 and started to decline under treatment with ivermectin. Our case confirms previous reports of eosinopenia in COVID-19, as it appears even in patients with chronic eosinophilia. Presence of eosinophilia should prompt screening for strongyloidiasis in all patients eligible for immunosuppressive therapy because of the risk of Strongyloides hyperinfection syndrome, especially if this treatment is empirical.
ABSTRACT
INTRODUCTION: Antisynthetase syndrome (ASSD) is a rare auto-immune condition that can present as interstitial lung disease (ILD) and progress into Acute Respiratory Distress Syndrome (ARDS). IMPORTANCE: The purpose of this clinical case is to highlight the importance of considering less prevalent causes of ARDS amid the COVID-19 pandemic. CASE REPORT: We present a 56-year-old Belgian female of African descent without past medical history who demonstrated typical signs of COVID-19 at the start of the pandemic. Based on the disease course as well as CT-scan findings, a diagnosis of COVID-19 was made. She progressed to ARDS for which she got intubated and was started on venovenous membrane oxygenation (VV-ECMO). Despite initial negative screening for antinuclear antibodies, further analysis revealed anti-Jo-antibodies. Diagnosis of ASSD was eventually retained and immunosuppressive therapy was started. However, pulmonary fibrosis had evolved too far and therapy was halted shortly after.