Pneumothorax in a patient with pneumonia caused by SARS-CoV-2: A case report

Ljiljana Novković; Ivan Čekerevac

doi:10.2298/VSP200604142N

Ljiljana Novković University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Ivan Čekerevac University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP200604142N

Keywords: covid-19, pneumonija, pneumotoraks, polimeraza, reakcija stvaranja lanaca, radiografija

Abstract

Uvod. Koronavirusna bolest 2019 (COVID-19) je akutna, infektivna multisistemska bolest koja se najčešće manifestuje akutnim respiratornim simptomima. Izaziva je severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nova koronavirusna pneumonija (NCP) je najčešća ozbiljna klinička manifestacija SARS-CoV-2 infekcije. U teškoj NCP ispoljene su i sistemske manifestacije bolesti, a jedna od retkih komplikacija, prvi put opisana u Vuhanu (Kina), je pneumotoraks. Prikaz bolesnika. Bolesnica stara 65 godina primljena je u Kliniku za pulmologiju zbog febrilnosti, otežanog disanja, gušobolje i opšte malaksalosti koje je imala prethodnih 5 dana. Laboratorijskim ispitivanjem otkriveni su limfopenija, povišene vrednosti parametara zapaljenja i lezija jetre. Radiografijom (RDG) grudnog koša utvrđeno je difuzno naglašen intersticijum i smanjena transparencija parenhima levo perihilarno. Prisustvo SARS-CoV-2 u uzorku nazofaringealnog brisa otkriveno je lančanom reakcijom polimeraze (PCR), čime je potvrđena dijagnoza NCP. Odmah je započeta terapija kiseonikom preko nazalne kanile protoka 8 L/min, uz hlorokin fosfat, antibiotike i simptomatsku terapiju. Osmog dana, stanje bolesnice se naglo pogoršalo i razvila je tešku hipoksemiju. Ponovljenom RDG grudnog koša potvrđen je kompletan pneumotoraks levo. Torakalna drenaža je uspešno izvedena uz potpunu reekspanziju pluća već sledećeg dana. Bolesnica je otpuštena iz bolnice u dobrom opštem stanju, sa normalnim gasovima arterijske krvi. Zaključak. Usled oštećenja alveola, pneumotoraks kao komplikacija pneumonije izazvane SARS-CoV-2, može nastati bez prethodnih plućnih oboljenja. Akutno pogoršanje sa naglom desaturacijom kiseonikom kod tih bolesnika trebalo bi da pobudi sumnju na pneumotoraks. Rana dijagnoza i brzo lečenje su neophodni za smanjenje smrtnosti.

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