A B S T R A C T Cytomegalovirus (CMV) pneumonia is a rare opportunistic infection in the setting of HIV (Human Immunodeficiency Virus)-infection. Establishing accurate diagnosis of CMV pneumonia in HIV-infection can be challenging. Co-infections by multiple opportunistic pathogens are common and a high degree of clinical vigilance to evaluate for multiple infections, including CMV pneumonia, should be maintained. As there can be a degree of overlap in clinical and radiological features amongst different opportunistic infections affecting the lungs, definitive microbiological and cytohistologic evidences are needed. Reliance on microbiological evidence of CMV in respiratory specimens alone for the diagnosis of CMV pneumonia will lead to an over-diagnosis of the condition and unnecessary treatment.In our case report, we describe a 53-year-old man with recently diagnosed HIV-infection who presented with non-resolving pneumonia. A diagnosis of CMV pneumonia was reached through consistent clinical, radiological, microbiological and cytologic investigations. The patient made a full clinical recovery after being started on anti-CMV treatment.
The coronavirus disease 2019 (COVID-19) pandemic has placed an immense burden on healthcare systems worldwide. There is intensive research targeted at better understanding of the virus pathogenicity, development of effective treatment strategies and vaccines against COVID-19. It is increasingly being recognised that the pathogenicity of COVID-19 extends beyond the respiratory system. In severe cases, there can be widespread activation of the immune system, vascular injury and a resultant pro-thrombotic state. Severe COVID-19 is widely regarded as a risk factor for venous thromboembolism. Interim European and American guidelines have been created to guide anticoagulation strategies in COVID-19 patients. However, it is unclear if these guidelines can be extrapolated directly to Asians, in whom there are differences in the baseline risk of thrombosis and bleeding. Our review article aimed to summarise the current understanding of arteriovenous thromboembolic complications in COVID-19 and discuss management strategies for prevention and treatment of thrombotic events in Asian COVID-19 patients.
INTRODUCTION: Pulmonary hypertension (PH) is an underdiagnosed complication of hereditary hemorrhagic telangiectasia (HHT), which is associated with increased mortality 1,2. CASE PRESENTATION: A 50-year old female non-smoker presented with shortness of breath for the past 1 year. Pertinent past history included HHT with pulmonary arteriovenous malformation (AVM), status post coil embolization of her pulmonary AVM 3 years ago. Computed tomography imaging of the thorax did not show new AVM or recanalization of previously embolized AVM. Pulmonary function tests were normal. Cardiopulmonary exercise test showed reduced exercise capacity, anaerobic threshold, oxygen pulse, VE/MVV and increased VE/CO2, with no ventilatory abnormality observed. She was evaluated with transthoracic echocardiogram which showed a pulmonary artery systolic pressure of 64mmHg. Transesophageal echocardiogram showed normal valvular function and intact interatrial and interventricular septum. Diagnostic right heart catheterization study demonstrated pulmonary capillary wedge pressure of 8mm Hg, cardiac output of 4.1L/min and mean pulmonary arterial pressure of 64mmHg. There was no step up in oxygenation from the inferior venous cava to the pulmonary artery to suggest intra-cardiac shunt. Pulmonary vascular resistance was markedly elevated at 11 Woods, suggesting pulmonary arterial hypertension (PAH) as the cause of PH.
Post-COVID-19 pulmonary sequalae are well-recognized early in the pandemic. Survivorship clinics are crucial for managing at-risk patients. However, it is unclear who requires pulmonary function test (PFT) and when PFTs should be performed. We aim to investigate for whom and how these interval PFTs should be performed. We performed a single-centre, prospective cohort study on COVID-19 survivors between 1st May 2020 to 31st April 2022. These patients were followed up at 6, 9 and 12 months with interval PFT and Short Form-36 (SF-36) Health Survey. Those with PFT defects were offered a computed tomography scan of the thorax. Of the 46 patients recruited, 17 (37%) had severe/critical illness. Compared to those with mild/moderate disease, these patients were more likely to experience DLCO defects (59% versus 17%, p = 0.005) and had lower SF-36 scores (mean physical component summary score of 45 ± 12 versus 52 ± 8, p = 0.046). These differences were most notable at 6 months, compared to the 9- and 12-months intervals. DLCO defects were also associated with older age, raised inflammatory markers and extensive CXR infiltrates. Besides interstitial-like abnormalities, obesity and undiagnosed lung conditions accounted for 39% of the PFT abnormalities. Interval PFTs can be performed earliest 6 months post-COVID-19. Patients with normal tests were unlikely to develop new abnormalities and would not require repeat PFTs. Abnormal PFTs can be followed-up with repeat PFTs 6 monthly until resolution. Non-COVID-19 differentials should be considered for persistent PFT abnormalities.
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