COVID-19 with Rapid Progression to Hypoxemia Likely due to Imbalance between Ventilation and Blood Flow: A Case Report

• Published in: Clinical medicine insights. Circulatory, respiratory and pulmonary medicine respiratory and pulmonary medicine, 2022, Vol.16, p.11795484211073273-11795484211073273
• Main Authors: Koriyama, Nobuyuki, Moriuchi, Akihiro, Higashi, Kensaku, Kataoka, Tetsuro, Arimizu, Takuro, Takaguchi, Go, Matsuoka, Hideki, Otsuka, Maki
• Format: Report
• Language: English
• ISSN: 1179-5484; 1179-5484
• DOI: 10.1177/11795484211073273

BACKGROUNDIn COVID-19 pneumonia, cases of severe hypoxemia in the early stage and cases of sudden deterioration in respiratory status due to silent hypoxia leading to death, have been reported. CASE SUMMARYA 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful. CONCLUSIONIn COVID-19 patients with multiple comorbidities who have hypoxemia and coagulation abnormalities that are disproportionate to the severity of pneumonia on CT, it is important to commence antiviral and anticoagulant therapy as soon as possible, followed by use of a low dose of Dex.