Asunto(s)
Dolor Abdominal/etiología , Enfermedades de las Glándulas Suprarrenales/patología , Enfermedad de Castleman/diagnóstico , Edema/patología , Fiebre/etiología , Dolor Abdominal/diagnóstico , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Azetidinas/administración & dosificación , Azetidinas/uso terapéutico , Médula Ósea/metabolismo , Médula Ósea/patología , Bortezomib/administración & dosificación , Bortezomib/uso terapéutico , Enfermedad de Castleman/tratamiento farmacológico , Enfermedad de Castleman/patología , Ciclosporina/administración & dosificación , Ciclosporina/uso terapéutico , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Quimioterapia Combinada , Fiebre/diagnóstico , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Inhibidores de las Cinasas Janus/administración & dosificación , Inhibidores de las Cinasas Janus/uso terapéutico , Masculino , Persona de Mediana Edad , Purinas/administración & dosificación , Purinas/uso terapéutico , Pirazoles/administración & dosificación , Pirazoles/uso terapéutico , Insuficiencia Renal/etiología , Reticulina , Sulfonamidas/administración & dosificación , Sulfonamidas/uso terapéutico , Trombocitopenia/etiologíaRESUMEN
Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.
Asunto(s)
COVID-19/patología , Pulmón/patología , Neumonía por Pneumocystis/patología , Insuficiencia Respiratoria/patología , Trombosis/patología , Lesión Renal Aguda/complicaciones , Insuficiencia Hepática Crónica Agudizada/complicaciones , Enfermedades de las Glándulas Suprarrenales/complicaciones , Enfermedades de las Glándulas Suprarrenales/patología , Autopsia , COVID-19/complicaciones , Coinfección/patología , Exudados y Transudados , Resultado Fatal , Fibrosis , Células Espumosas/patología , Hemorragia/complicaciones , Hemorragia/patología , Humanos , Hipertensión/complicaciones , Hepatopatías Alcohólicas/complicaciones , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Neumonía por Pneumocystis/complicaciones , Arteria Pulmonar/patología , Venas Pulmonares/patología , Insuficiencia Respiratoria/etiología , SARS-CoV-2 , Trombosis/etiologíaRESUMEN
CONTEXT: Bilateral adrenal hemorrhage is a rare condition with potentially life-threatening consequences such as acute adrenal insufficiency. Early adrenal axis testing, as well as directed imaging, is crucial for immediate diagnosis and treatment. Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy and thromboembolic events. CASE DESCRIPTION: A 66-year-old woman presented with acute COVID-19 infection and primary adrenal insufficiency due to bilateral adrenal hemorrhage (BAH). She also had a renal vein thrombosis. Her past medical history revealed primary antiphospholipid syndrome (APLS). Four weeks after discharge she had no signs of COVID-19 infection and her polymerase chain reaction test for COVID-19 was negative, but she still needed glucocorticoid and mineralocorticoid replacement therapy. The combination of APLS and COVID-19 was probably responsible of the adrenal event as a "two-hit" mechanism. CONCLUSIONS: COVID-19 infection is associated with coagulopathy and thromboembolic events, including BAH. Adrenal insufficiency is life threatening; therefore, we suggest that early adrenal axis testing for COVID-19 patients with clinical suspicion of adrenal insufficiency should be carried out.