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Case Reports
. 2020 Nov;15(11):2378-2381.
doi: 10.1016/j.radcr.2020.09.026. Epub 2020 Sep 18.

Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia

Daniel A Placik  1 , Wesley L Taylor  1 , Nathan M Wnuk  2
Affiliations
Case Reports

Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia

Daniel A Placik et al. Radiol Case Rep. 2020 Nov.

Abstract

COVID-19 pneumonia has demonstrated a wide spectrum of clinical presentations that has yet to be completely uncovered. We discuss the case of a 49-year-old male who presented to the emergency department with fever, cough, and shortness of breath. Initial chest X-ray suggested viral pneumonia that was confirmed to be due to COVID-19. He was treated with empiric antibiotics, antiviral therapy, high-dose glucocorticoids, and interleukin antagonists. Two weeks into the patient's hospital course, he rapidly decompensated with subsequent chest X-ray and CT chest confirming tension pneumothorax with bronchopleural fistula. Intraoperative samples of the necrotic empyema identified mucormycosis invading the lung parenchyma with follow-up microbiology results confirming Rhizopus species. In this case report, we explore the possibility that the patient's immunocompromised state may have contributed to the patient's development of mucormycosis and subsequent development of bronchopleural fistula.

Keywords: COVID; Dexamethasone; Mucormycosis; Pneumonia; Remdesivir; Tocilizumab.

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Figures

Fig 1
Fig. 1
Initial chest X-ray on presentation revealing typical SARS-CoV-2 pneumonia without any evidence of right upper lobe lesions.
Fig 2
Fig. 2
Chest X-ray showing bilateral pneumonia with a persistent right pneumothorax and developing cavitary lesion in right upper lobe.
Fig 3
Fig. 3
Coronal view of CT chest confirming the cavitary lesion and persistent pneumonia despite the presence of 2 chest tubes.
Fig 4
Fig. 4
Axial view of CT chest revealing a persistent right pneumothorax and an air-filled bullous process with questionable fistula of the bronchi to this region.
See this image and copyright information in PMC

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