D-dimer in Coronavirus Disease 2019 pneumonia: A valuable inflammatory marker in predicting trends of systemic effects in addition to thromboembolic events! A single-center experience

Patil, Shital; Toshniwal, Sham; Khule, Shubhangi

doi:10.4103/jascp.jascp_46_22

Cited by 2 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the first wave, extrapulmonary manifestations as pseudo acute coronary syndrome, pulmonary thromboembolism, and stroke were documented in a greater number of cases as compared to the second wave. Rapidly evolving pneumonia or "accelerated acute respiratory distress syndrome" (ARDS) was more commonly documented in the second wave, i.e., the larger number of cases were presented with rapidly deteriorating radiological and clinical laboratory parameters as increased computed tomography severity score, worsened oxygenation, increased inflammatory markers like CRP [4][5][6][7], LDH [8][9][10][11], Ferritin [12][13][14][15], IL-6 [16][17][18][19][20][21] and D-Dimer [22][23][24][25][26]. In present case report we have observed bronchopneumonia like radiological pattern in HRCT thorax in COVID-19 pneumonia as a clinical radiological pathological phenotype.…”

Section: Introductionmentioning

confidence: 99%

Covid-19 Pneumonia Presenting as a ‘Typical Radiological Bronchopneumonia’ Pattern in Clinical-Radiological-Pathological Phenotype with Transient Hyperglycemia

Patil,

Tak

2024

SAR J Med

View full text Add to dashboard Cite

Radiological phenotypes are radiological patterns or observable characteristics of COVID19 pneumonia. Various phenotypic classifications have been reported in literature. CT severity radiological phenotypes are widely used and universally accepted radiological phenotypic methods. Radiological CT severity phenotypic differentiation has documented very crucial role in initial assessment and during triaging of these cases in indoor and outdoor setting. Typical COVID-19 lung parenchymal involvement described as predominant ground glass opacities (GGOs) and consolidations in peripheral and subpleural portion of any lobe, predominantly involving lower lobes. Atypical Radiological patterns in COVID-19 has been documented as bronchopneumonia, multifocal consolidations, necrotizing pneumonia, cavitations with GGOs with or without consolidations. In present case report, 43-year male, presented with acute febrile respiratory illness with acute hypoxic respiratory failure documented as oxygen saturation of 80% at room air with tachypnea and respiratory distress. HRCT thorax was showing Pleural based, peripheral, central, multifocal patchy, confluent & ill-defined GGOs and consolidations in bilateral lung fields in upper, middle and lower lobes. These typical radiological features suggestive of bronchopneumonia like radiological pattern which was very unusual for typical COVID-19 radiology. His laboratory parameters have shown abnormally raised inflammatory markers like CRP, Ferritin, LDH, D-Dimer and IL-6. Importantly, his random blood sugars were raised with abnormally raised HbA1c levels to label as diabetes mellitus. He was diagnosed with diabetes mellitus this time with COVID-19 illness without use of steroids. He was treated with standardized COVID-19 management institutional protocol with combination of low molecular weight heparin, methylprednisolone, remdesivir, meropenem and teicoplanin. Patient required BIPAP support with higher oxygen requirement with nasals canula for one week due to advanced radiological disease with more anatomical involvement. We have documented successful treatment outcome with use of rational treatment in timely by predicting disease severity with use of composite analysis of clinical, laboratory and radiological markers of illness. Transient hyperglycemia is known to occur and reported after COVID-19 illness due to virus induced inflammatory response and pancreatopathy with beta cell dysfunction. Transient hyperglycemia can be easily managed with insulin during hospitalization and oral anti-diabetic agents after discharge for few weeks. Dietary and lifestyle modification will help in majority with complete reversal of abnormally high sugar levels with restoration of normal HbA1c levels to non-diabetic range.

show abstract

Section: Introductionmentioning

confidence: 99%

Covid-19 Pneumonia Presenting as a ‘Typical Radiological Bronchopneumonia’ Pattern in Clinical-Radiological-Pathological Phenotype with Transient Hyperglycemia

Patil,

Tak

2024

SAR J Med

View full text Add to dashboard Cite

show abstract

“…In the first wave, extra pulmonary manifestations as pseudo acute coronary syndrome, pulmonary thromboembolism, and stroke were documented in a greater number of cases as compared to the second wave. Rapidly evolving pneumonia or "accelerated acute respiratory distress syndrome" (ARDS) was more commonly documented in the second wave, i.e., the larger number of cases were presented with rapidly deteriorating radiological and clinical laboratory parameters as increased computed tomography severity score, worsened oxygenation, increased inflammatory markers like CRP [4][5][6][7], LDH [8][9][10][11], Ferritin [12][13][14][15], IL-6 [16][17][18][19][20][21] and D-Dimer [22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Unilateral Lung Parenchymal Infiltrates with GGO & Evolving Consolidation as Presenting Feature of Sporadic COVID-19 Pneumonia in Post Pandemic Era in a Patient with Acute Febrile Respiratory Illness

Patil,

Tak

2024

SAR J Med

View full text Add to dashboard Cite

Sporadic COVID-19 cases will be predicted to occur in coming few years ahead as observed in previously known influenza virus related pandemics. Herd immunity due to natural infection and hybrid immunity after COVID-19 vaccination has played crucial role in waning of this pandemic. COVID-19 pneumonia has a very ‘typical’ radiological presentations, observed globally; classified as GGO and consolidations involving peripheral parts of lung, bilateral disease, predominantly pleural based areas initially and involves central portions as disease process advances. Such radiological presentations are never documented in history before this pandemic, which has helped in suspecting COVID-19 illness in cases with negative microbiological results initially and such illness were classified as SARI (severe acute respiratory illness). Cases with typical radiological features for COVID-19 with RT PCR positive results were defined as case of COVID-19 illness. Both the clinical scenarios were managed with similar protocol during hospitalization. COVID-19 case burden has significantly decreased in last one year since declaration of end of pandemic by WHO and now we are in post pandemic phase. Since beginnings of pandemic, many corona virus variants were emerged with variable infectivity, virulence, pathogenesis, mortality and morbidity. As pandemic is over, cases are rarely observed with lung involvement, COVID RT PCR testing, HRCT reporting’s in line with pandemic protocol and requirement of resources to treat these cases are less required and utilized today. In present case report, 32-year male, presented in outdoor unit with history of acute febrile respiratory illness with dry cough, high grade fever and chest tightness and chest discomfort of acute onset. HRCT thorax documented Pleural based, peripheral, unifocal or solitary opacity with predominant GGOs in right lower lobe with normal left lung. He is treated in indoor unit in line with community acquired pneumonia protocol and observed clinical worsening with four-fold raised in inflammatory markers. Oxygenation is worsened and raised IL-6, CRP and LDH has given clue to think towards COVID-19 etiology. Thorat swab for COVID-19 RT PCR is positive and managed according to protocol for COVID-19 illness. This is the only observed COVID-19 pneumonia case in last six months, in which; clinical-radiological patters were typical of pandemic illness of second wave of COVID-19 illness due to delta variant. Our case is the sporadic case reported with all clinical features of pandemic illness. We have suspected COVID-19 etiology in spite of ‘atypical unilateral lung involvement’ due to worsened clinical features and abnormally raised inflammatory markers with poor response to standard treatment protocol for community acquired pneumonia. High index of suspicion is must, and; timely interventions with use of rational treatment including remdesivir, heparin & steroids combination during hospitalization has documented successful outcome. We recommend COVID-19 RT PCR testing in all community acquired cases nonresponding to standard guidelines to have timely diagnosis and treatment. Sporadic cases rare to occur, and they do occur for few years ahead of this end of pandemic due to virus variant, and we must quote ‘rare things are not rare to happen’.

show abstract

D-dimer in Coronavirus Disease 2019 pneumonia: A valuable inflammatory marker in predicting trends of systemic effects in addition to thromboembolic events! A single-center experience

Cited by 2 publications

References 0 publications

Covid-19 Pneumonia Presenting as a ‘Typical Radiological Bronchopneumonia’ Pattern in Clinical-Radiological-Pathological Phenotype with Transient Hyperglycemia

Covid-19 Pneumonia Presenting as a ‘Typical Radiological Bronchopneumonia’ Pattern in Clinical-Radiological-Pathological Phenotype with Transient Hyperglycemia

Unilateral Lung Parenchymal Infiltrates with GGO & Evolving Consolidation as Presenting Feature of Sporadic COVID-19 Pneumonia in Post Pandemic Era in a Patient with Acute Febrile Respiratory Illness

Contact Info

Product

Resources

About