Pneumatocele formation following COVID-19 pneumonia

A 61-year-old man with no significant medical history presented to the emergency department with worsening dyspnea a week after close con-tact with someonewhohad COVID-19. Hewas unvaccinated. He washypoxemic, and the chest radiograph showed bilateralopacities consistent withCOVID-19 pneumonia and tested positive for RNA from SARS-CoV-2. Blood tests showed raised inflammatory markers. Computed tomography (CT)of the chest demonstrated bilateralground-glass opacities. Thepatient washospitalized andtreated with high-flow nasaloxygentherapy, dexameth-asone, and sarilumab. His clinical status improved, and hewas discharged home after 1 week of hospitalization.Three weekslater, hepresented againwith worsening dyspnea, fever, and pleuritic chest pain. A CT pulmonary angiography ruled out pulmonary embolism (Fig. 1A, B) but demonstrated athin-walled cystic lesion with an air–fluid level (Fig. 1A, arrowheads) that suggested an infected pneumatocele. The patient was managed conserva-tively with amoxicillin/clavulanic acid for 3 weeks. During the follow-up, the patient reported the disappearance of symptomatology

Pneumatocele formation following COVID-19 pneumonia

A 61-year-old man with no significant medical history presented to the emergency department with worsening dyspnea a week after close con-tact with someonewhohad COVID-19. Hewas unvaccinated. He washypoxemic, and the chest radiograph showed bilateralopacities consistent withCOVID-19 pneumonia and tested positive for RNA from SARS-CoV-2. Blood tests showed raised inflammatory markers. Computed tomography (CT)of the chest demonstrated bilateralground-glass opacities. Thepatient washospitalized andtreated with high-flow nasaloxygentherapy, dexameth-asone, and sarilumab. His clinical status improved, and hewas discharged home after 1 week of hospitalization.Three weekslater, hepresented againwith worsening dyspnea, fever, and pleuritic chest pain. A CT pulmonary angiography ruled out pulmonary embolism (Fig. 1A, B) but demonstrated athin-walled cystic lesion with an air–fluid level (Fig. 1A, arrowheads) that suggested an infected pneumatocele. The patient was managed conserva-tively with amoxicillin/clavulanic acid for 3 weeks. During the follow-up, the patient reported the disappearance of symptomatology

Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study

Abstract. Recalde-Zamacona B, Tomas-Vel azquez A, Campo A, Satrustegui-Alzugaray B, Fern andez- Alonso M, Inigo M, Rodr ~ ıguez-Mateos M, Di Frisco M, Felgueroso C, Berto J, Mar ın-Oto M, Alcaide AB, Zulueta JJ, Seijo L, Landecho MF (Clinica Universidad de Navarra; Health Center of San Juan, Pamplona, Spain). Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study. J Intern Med 2021; 289: 921– 925. https://doi.org/10.1111/joim.13237 Background. SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient’s basal clinical conditions. Methods. We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with pro- longed viral shedding and compared them with 36 sex-matched randomly selected controls. Demo- graphic, treatment and clinical data were system- atically collected. Results. Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22–39.3 days), 48.5 days in cases (IQR 38.7–54.9 days) and 23 days in controls (IQR 20.2–25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups.Chronic rhinosi- nusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Mul- tivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89– 90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. Conclusion. We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospec- tive trials, this finding might have clinical implica- tions for quarantine duration due to increased risk of pandemic spread