Elsevier

Radiology Case Reports

Volume 15, Issue 11, November 2020, Pages 2378-2381
Radiology Case Reports

Case Report
Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia

https://doi.org/10.1016/j.radcr.2020.09.026Get rights and content
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open access

Abstract

COVID-19 pneumonia has demonstrated a wide spectrum of clinical presentations that has yet to be completely uncovered. We discuss the case of a 49-year-old male who presented to the emergency department with fever, cough, and shortness of breath. Initial chest X-ray suggested viral pneumonia that was confirmed to be due to COVID-19. He was treated with empiric antibiotics, antiviral therapy, high-dose glucocorticoids, and interleukin antagonists. Two weeks into the patient's hospital course, he rapidly decompensated with subsequent chest X-ray and CT chest confirming tension pneumothorax with bronchopleural fistula. Intraoperative samples of the necrotic empyema identified mucormycosis invading the lung parenchyma with follow-up microbiology results confirming Rhizopus species. In this case report, we explore the possibility that the patient's immunocompromised state may have contributed to the patient's development of mucormycosis and subsequent development of bronchopleural fistula.

Keywords

COVID
Pneumonia
Mucormycosis
Dexamethasone
Remdesivir
Tocilizumab

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Signed consent for a case report was obtained from the patient's legally authorized representative (LAR).

Declaration of competing interest: None.