Severe COVID-19 with acute respiratory distress syndrome (ARDS) in a sickle cell disease adult patient: case report.
BMC Pulm Med
; 21(1): 46, 2021 Jan 29.
Article
in English
| MEDLINE | ID: covidwho-1054817
ABSTRACT
BACKGROUND:
Sickle-cell anaemia is a widespread genetic disease prevalent worldwide among African and African-American populations. The pathogenesis is most often revealed by pulmonary conditions, including acute thoracic syndrome, which is affecting the life expectancy of these populations. The global spread of CoV2-SARS infection with a respiratory tropism, endothelial damages and procoagulant status endangers the SCD population. However, with only a few case reports, consequences of the Covid-19 pandemic on SCD population remain poorly known. CASE PRESENTATION We report a case of a 33-year-old man with a history of homozygous SS homozygous sickle cell anemia who consulted on March 24, 2020 for febrile dyspnea 11 days after the onset of symptoms. A nasopharyngeal swab was positive for SARS-CoV-2. His respiratory status worsened rapidly in the emergency room and then in ICU leading to severe ARDS requiring intubation, curarization, and venovenous ECMO. Hematologically, severe hemolysis associated with major thrombocytopenia without documented spinal cord injury was noted. Several transfusion exchanges are performed. The evolution was finally slowly favorable and led to discharge from the intensive care unit and then from the hospital.CONCLUSIONS:
This case recalls the importance of an increased prevention policy against COVID-19among the SCD population. In addition, from a therapeutic point of view, it advocates (1) a high preventive anticoagulation from the outset according to the level of D-dimers (2) the use of venovenous ECMO in this particular case, whereas this technique has had rather disappointing results in acute chest syndromes. (3) Unexpectedly, our patient did not develop pulmonary arterial hypertension (PAH) and acute cor pulmonale (ACP), whereas this is a common feature of ARDS during SCD. These last two observations suggest a different pathophysiology of pulmonary disorders in SCD patients in the case of SARS COv2. It could be associated with marked hypoxemia secondary to pulmonary vascular vasodilation.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Respiration, Artificial
/
Respiratory Distress Syndrome
/
Extracorporeal Membrane Oxygenation
/
SARS-CoV-2
/
COVID-19
/
Anemia, Sickle Cell
Type of study:
Case report
/
Diagnostic study
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Adult
/
Humans
/
Male
Language:
English
Journal:
BMC Pulm Med
Year:
2021
Document Type:
Article
Affiliation country:
S12890-021-01412-x
Similar
MEDLINE
...
LILACS
LIS