Spontaneous alveolo-pleural fistula in a case of COVID-19 pneumonia-challenges and solutions: case report
DOI:
https://doi.org/10.18203/2349-2902.isj20215162Keywords:
COVID-19, Necrotizing pneumonia, Persistent air-leak, Alveolo-pleural fistulaAbstract
COVID-19 pneumonia has demonstrated a wide spectrum of clinical presentations that have yet to be completely uncovered. As this pandemic progresses, uncommon presentations of this disease have come into light. Development of broncho/alveolo-pleural fistula in a patient with COVID-19 pneumonia is a rare phenomenon with only 4 cases reported in literature till date. A 61-year-old gentleman presented to the emergency department with fever, cough, and shortness of breath. His initial chest X-ray was suggestive of a viral pneumonia that was later confirmed to be due to COVID-19. The patient was put on non-invasive ventilator support and treated with empirical antibiotics, glucocorticoids, anti-viral medications and convalescent plasma therapy. Four weeks into the patient’s hospital course, his vital parameters suddenly deteriorated with a subsequent chest X-ray showing a tension pneumothorax, for which a chest tube insertion was done. However, when the air leak did not resolve by the 3rd day, a chest computed tomography (CT) was planned which showed a spontaneous alveolo-pleural fistula (APF). The patient was managed with conservative treatment using negative suction applied to an underwater seal, had his chest tube removed 10 days later and was discharged subsequently. Spontaneous fistulisation between broncho-alveolar tree and pleura can occur rarely in patients with COVID-19 pneumonia and can be managed using underwater seal with negative suction, insertion of endobronchial valves or surgical closure, and needs to be individualised.
References
Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review. Am J Trop Med Hyg. 2020;103:1170-6.
Hsieh YC, Wang C-W, Lai S-H, Lai J-Y, Wong K-S, Huang Y-C et al. Necrotizing Pneumococcal pneumonia with bronchopleural fistula among children in Taiwan. Pediatr Infect Dis J. 2011;30:740-4.
Beigee SF, Toutkaboni PM, Khalili N, Nadji SA, Dorudinia A, Rezaei M et al. Diffuse alveolar damage and thrombotic microangiopathy are the main histopathological findings in lung tissue biopsy samples of COVID-19 patients. Pathol Res Pract. 2020;216:153228.
Lax SF, Skok K, Zechner P, Kessler HH, Kaufmann N, Koelblinger C et al. Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome: Results from a Prospective, Single-Center, Clinicopathologic Case Series. Ann Intern Med. 2020;173:350-61.
Pathak V, Waite J, Chalise SN. Use of endobronchial valve to treat COVID-19 adult respiratory distress syndrome-related alveolopleural fistula. Lung India. 2021;38:S69-71.
Talon A, Arif MZ, Mohamed H, Khokar A, Saeed AI. Bronchopleural Fistula as a Complication in a COVID-19 Patient Managed with Endobronchial Valves. J Investig Med High Impact Case Rep. 2021;9:23247096211013215.
Placik DA, Taylor WL, Wnuk NM. Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia. Radiol Case Rep. 2020;15:2378-81.
Peeters K, Mesotten D, Willaert X, Deraedt K, Nauwelaers S, Lauwers G. Salvage Lobectomy to Treat Necrotizing SARS-CoV-2 Pneumonia Complicated by a Bronchopleural Fistula. Ann Thorac Surg. 2021;111:e241-3.