Platypnea-orthodeoxia syndrome in SARS-CoV-2 related ARDS: a case report

Platypnea-orthodeoxia syndrome in SARS-CoV-2 related ARDS: a case report

Authors

  • Concetta Aprea University of Campania “Luigi Vanvitelli”
  • Simona Imbriani University of Campania “Luigi Vanvitelli”
  • Giovanna Cirigliano University of Campania “Luigi Vanvitelli”
  • Klodian Gjeloshi University of Campania “Luigi Vanvitelli”
  • Luciana Agnese Meo University of Campania “Luigi Vanvitelli”
  • Andrea Padula University of Campania “Luigi Vanvitelli”
  • Roberta Ranieri University of Campania “Luigi Vanvitelli”
  • Carmen Ricozzi University of Campania “Luigi Vanvitelli”
  • Carolina Ruosi University of Campania “Luigi Vanvitelli”
  • Domenico Cozzolino University of Campania “Luigi Vanvitelli”
  • Luigi Elio Adinolfi University of Campania “Luigi Vanvitelli”
  • Riccardo Nevola a:1:{s:5:"en_US";s:41:"University of Campania "Luigi Vanvitelli"";}

Keywords:

COVID-19, SARS-CoV-2, Platypnea-Orthodeoxia Syndrome, ARDS

Abstract

Platypnea-Orthodeoxia Syndrome (POS) is an often misdiagnosed clinical condition characterized by dyspnea and hypoxia in sitting or semi-sitting position, reversible in supine position. Although POS is typically associated with intracardiac shunts, it seems frequent also in SARS-CoV-2 related Acute Respiratory Distress Syndrome (ARDS). In fact, the prevalent involvement of the lung bases due to interstitial pneumonia can determine refractory positional hypoxemia, with marked desaturation in the sitting position and regression or improvement in the supine position, configuring the clinical picture of the POS. We present a clinical case of POS associated with acute respiratory distress from SARS-CoV-2 pneumonia in which refractory hypoxia would have required support by invasive mechanical ventilation if the syndrome had not been identified.

References

Montenegro F, Unigarro L, Paredes G, et al. Acute respiratory distress syndrome (ARDS) caused by the novel coronavirus disease (COVID-19): a practical comprehensive literature review. Expert Rev Respir Med 2021; 15: 183-195.

Guérin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 2020; 46: 2385-2396.

Agrawal A, Palkar A, Talwar A. The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review. Respir Med 2017; 129: 31-38.

Lugara M, Oliva G, Pafundi PC, et al. Clinical application of lung ultrasound score on COVID-19 setting: a regional experience in Southern Italy. Eur Rev Med Pharmacol Sci 2021; 25: 3623-3631.

Chang YC, Yu CJ, Chang SC, et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology 2005; 236: 1067-75.

National Istitutes of Health (NIH). COVID-19 Treatment Guidelines. https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/ Date last updated: October 27, 2021. Date last accessed: November 29, 2021.

Agenzia Italiana del Farmaco (AIFA). https://www.aifa.gov.it/en/web/guest/home. Date last updated: October 21, 2021. Date last accessed: November 29, 2021.

Tan GP, Ho S, Fan BE, et al. Reversible platypnea-orthodeoxia in COVID-19 acute respiratory distress syndrome survivors. Respir Physiol Neurobiol 2020; 282:103515.

Vanhomwegen C, Taton O, Selvais N, Vanhove O, Leduc D. Patent foramen ovale revealed by COVID-19 pneumonia. BMC Pulm Med 2021; 21: 126.

Dodson BK, Major CK, Grant M, Yoo BS, Goodman BM. Platypnea Orthodeoxia Due to a Patent Foramen Ovale and Intrapulmonary Shunting After Severe COVID-19 Pneumonia. Am J Case Rep 2021; 22: e933975.

Jenab Y, Hosseinsabet A, Vaskelyte L, Hosseini K. Platypnoea-orthodeoxia syndrome after percutaneous treatment of ruptured sinus Valsalva complicated by SARS-Cov-2 pneumonia: a case report. Eur Heart J Case Rep 2021; 5: ytab176.

Longo C, Ruffini L, Zanoni N, et al. Platypnea-orthodeoxia after fibrotic evolution of SARS-CoV-2 interstitial pneumonia. A case report. Acta Biomed 2020; 91: ahead of print.

Singh K, Kadnur H, Ray A, et al. Platypnea-orthodeoxia in a patient with severe COVID-19 pneumonia. Monaldi Arch Chest Dis 2020; 90.

Tham SL, Ong PL, Lee AJY, Tay MRJ. Rehabilitation of Patients with Platypnea-Orthodeoxia Syndrome in COVID-19 Pneumonia: Two Case Reports. J Rehabil Med Clin Commun 2020; 3: 1000044.

Hoshi T, Tadokoro Y, Nemoto M, Honda J, Matsukura S. Platypnea-orthodeoxia syndrome associated with COVID-19 pneumonia: a case report. JA Clin Rep 2021; 7: 67.

Salvotti F, Poiatti F, Bressa S, Montani G, Nardin M, Rizzoni D. Platypnoea-Orthodeoxia Syndrome in COVID-19. Eur J Case Rep Intern Med 2021;8: 002849.

Athavale T, Athavale A, Khatri V, et al. Platypnea-orthodeoxia Syndrome (POS) in Moderate COVID-19: An Uncommonly Common Bedside Sign? J Assoc Physicians India 2021; 69: 11-12.

Herrmann J, Mori V, Bates JHT, Suki B. Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia. Nat Commun 2020; 11: 4883.

Pfeifer M, Ewig S, Voshaar T, et al. Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19. Respiration 2020; 99: 521-542.

Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med 2020; 8: 681-686.

Rajendram R, Kharal GA, Puri R. COVID-19 May Be Exacerbated by Right-to-Left Interatrial Shunt. Ann Thorac Surg 2021; 111: 376.

Torres-Valencia J, Quevedo-Mori A, Untiveros-Mayorga F. Hypoxemia, high alveolar-arterial gradient, and bubbles in both sides of heart: A case of hepatopulmonary syndrome in the setting of COVID-19 pandemic. Clin Case Rep 2021; 9: e04204.

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Published

07-06-2022

How to Cite

1.
Aprea C, Imbriani S, Cirigliano G, Gjeloshi K, Meo LA, Padula A, et al. Platypnea-orthodeoxia syndrome in SARS-CoV-2 related ARDS: a case report. Acta Biomed [Internet]. 2022 Jun. 7 [cited 2024 Jul. 13];93(S1):e2022102. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12824