Clinical course of COVID-19 pneumonia in a patient undergoing pneumonectomy and pathology findings during the incubation period

Abstract

BACKGROUND The cause of coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical information about patients undergoing lung resection while infected with this virus and pathological information about early COVID-19 pneumonia are still scarce. CASE PRESENTATION A 69-year-old male patient underwent a right pneumonectomy for squamous cell lung carcinoma. Until the fourth postoperative day, the patient, who had minor radiological changes on chest x-ray, was asymptomatic. From this day, the COVID-19 test, which was performed after the appearance of symptoms such as fever and shortness of breath, lymphopenia and diffuse ground glass opacity in the left lung on computed tomography, was reported to be positive. The patient was given NIMV (non-invasive mechanical ventilation), and hydroxychloroquine, favipiravir and azithromycin in isolation intensive care, with the diagnosis of severe pneumonia. He was discharged on the 17th postoperative day with healing of the lung lesions. The pathology specimen of the patient, who was found to have been infected with SARS-CoV-2 before the day of surgery, was examined retrospectively. Irregular and severe pneumocyte hyperplasia, interstitial thickening, oedema, pronounced protein exudates, diffuse enlargement of the alveolar walls, macrophage infiltration and fibroblastic proliferation, which is an indicator of early organisation, were detected. CONCLUSION We believe that the clinical course and pathology findings obtained after right pneumonectomy in a patient with pre-symptomatic COVID-19 pneumonia will guide the diagnosis and treatment of patients infected with SARS-CoV-2.

A Case of Suspected Radiation Recall Pneumonitis After a COVID-19 Infection

“…Moreover, the pathology report had incidental findings of early-stage COVID-19 when surgery performed for lung cancer included edema, prominent proteinaceous exudates, vascular congestion, and inflammatory clusters with fibrinoid material [ 8 , 9 ]. This could indicate with some possibility that a small amount of SARS-CoV-2 virus was deposited in the alveolae of both lungs and could cause cytokine release, leading to radiation recall pneumonia.…”

The management of postoperative COVID-19 pneumonia in a case with right pneumonectomy

“…Common symptoms at the onset of illness are fever (98%), cough (76%), and myalgia or fatigue (44%), while dyspnea can be also seen in 55% of patients. [ 3 , 4 ] Dyspnea and cough are expected symptoms in the early postoperative period in pneumonectomized patients. The reasons can be listed as follows: decrease in respiratory capacity after resection, infection, bronchopleural fistula, and hemorrhage.…”

“…[5] Peripherally located GGO and consolidation were also detected on thoracic CT in our patient. If COVID-19 pneumonia causes acute respiratory distress syndrome (30%), bilateral diffuse consolidations are observed in thoracic CT. [3][4][5][6][7] The diagnosis of COVID-19 must be confirmed by SARS-CoV-2 RT-PCR testing. However, with limitations of sample collection and transportation and inadequate kit performance, the total positive rate of SARS-CoV-2 RT-PCR for throat swab samples was reported to be about 30 to 60% at the initial presentation.…”

Description of Leukocytes in Patients who are Positive for COVID-19 Infection

“…During the incubation period (1-14 days) or at the beginning of the disease phase, which appears in the appearance of nonspecific symptoms, the results of the leukocyte and lymphocyte counts are low or within normal limits. 34 But after 7-14 days of symptoms, there begins to be an increase in inflammatory mediators along with cytokines and chemokines which we know is a "cytokine storm". Then, there will be a change in the number of lymphocytes, which becomes very low (lymphopenia), and there will also be an increase in the number of leukocytes (leukocytosis).…”