Spontaneous Hemoptysis in a Patient With COVID-19

Abstract

Case Presentation A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. His medical history included hypertension, diabetes mellitus, chronic kidney disease, morbid obesity, paroxysmal atrial fibrillation, and tobacco use. He was taking amiodarone, carvedilol, furosemide, pregabalin, and insulin. The patient appeared to be in mild respiratory distress. He was afebrile and had saturation at 93% on 3 L of oxygen, heart rate of 105 beats/min, BP of 145/99 mm Hg, and respiratory rate of 18 breaths/min. On auscultation, there were crackles on bilateral lung bases and chronic bilateral leg swelling with hyperpigmented changes. His WBC count was 6.0 K/cumm (3.5 to 10.6 K/cumm) with absolute lymphocyte count 0.7 K/cumm (1.0 to 3.8 K/cumm); serum creatinine was 2.81 mg/dL (0.7 to 1.3 mg/dL). He had elevated inflammatory markers (serum ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and creatinine phosphokinase). Chest radiography showed bilateral pulmonary opacities that were suggestive of multifocal pneumonia ( Fig 1 ). Nasopharyngeal swab for SARS-CoV-2 was positive. Therapy was started with ceftriaxone, doxycycline, hydroxychloroquine, and methylprednisolone 1 mg/kg IV for 3 days. By day 3 of hospitalization, he required endotracheal intubation, vasopressor support, and continuous renal replacement. Blood cultures were negative; respiratory cultures revealed only normal oral flora, so antibiotic therapy was discontinued. On day 10, WBC count increased to 28 K/cumm, and chest radiography showed persistent bilateral opacities with left lower lobe consolidation. Repeat respiratory cultures grew Pseudomonas aeruginosa ( Table 1 ) . Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.

Bronchial Artery Embolization for Life-Threatening Hemoptysis in COVID-19 Patients

“…Therapy with IV voriconazole was started and continued for a total of 6 weeks with the resolution of hemoptysis without BAE. 19 Sato et al 20 had two interesting observations. First, the fact that COVID-19 pneumonia can lead to lung bulla even without mechanical ventilation or a history of pulmonary disease.…”

“…Spontaneous intrapulmonary bleeding and hemoptysis are typical complications of IPA. 18 Pasula and Chandrasekar 19 reported one critically ill patient with COVID-19 suffering from spontaneous hemoptysis, elevated serum levels of galactomannan, β-D glucan, positive Asp ergillus niger fungal culture, and radiologic evidence of cavitary. Therapy with IV voriconazole was started and continued for a total of 6 weeks with the resolution of hemoptysis without BAE.…”

“…Therapy with IV voriconazole was started and continued for a total of 6 weeks with the resolution of hemoptysis without BAE. 19…”