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Filippini A, Bnà C, Bellosta R, Bazzani R, Luzzani L, Pegorer MA, Zandalasini M, Baldon M, Codazzi M, Sabatini T. COVID-19 acute respiratory distress syndrome: can iloprost have a role for the treatment? Respir Med Case Rep 2021; 32:101358. [PMID: 33552890 PMCID: PMC7847284 DOI: 10.1016/j.rmcr.2021.101358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023] Open
Abstract
Pulmonary infection of 2019-nCoV can frequently induce acute respiratory distress syndrome (ARDS) with partial pressure of arterial oxygen/fraction of inspired oxygen ratio (pO2/FiO2) of less than 300 mmHg. Moreover, it can be complicated with cardiac injury or arrhythmia, microvascular and large-vessel thrombosis. We describe a case of a patient with COVID19-ARDS and concomitant critical ischemia of the limbs. Iloprost treatment, an analogue of a prostacyclin PGI2, was started for residual left forefoot ischemia after surgical thromboembolectomy. Unexpectedly, we documented improvement of respiratory performance and lung high resolution computed tomography (HRCT) showed significant regression of the diffuse pulmonary ground-glass opacity. The hypothetical mechanism is that iloprost can enhance perfusion preferentially to well-ventilated lung regions, reduce pressures of peripheral pulmonary vessels and induce reduction of lung interstitial edema. In addition, iloprost antithrombotic effect, endothelial damage repairing and neo-angiogenesis activity could play a relevant role.
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Affiliation(s)
- Alida Filippini
- Department of Internal Medicine, Gastroenterology and Endoscopy. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
- Corresponding author.
| | - Claudio Bnà
- Department of Radiology. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Roberto Bazzani
- Department of Internal Medicine, Gastroenterology and Endoscopy. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Luca Luzzani
- Department of Vascular Surgery. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Matteo Alberto Pegorer
- Department of Vascular Surgery. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Matteo Zandalasini
- Department of Specialistic Rehabilitation. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Michela Baldon
- Department of Specialistic Rehabilitation. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Manuela Codazzi
- Department of Gastroenterology and Endoscopy. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
| | - Tony Sabatini
- Department of Internal Medicine, Gastroenterology and Endoscopy. Poliambulanza Hospital Clinical Institute, Via Bissolati 57, 25124 Brescia, Italy
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