Non-Infectious Pneumonitis and Acute Respiratory Distress Syndrome in a Patient on Ustekinumab Treatment: Case Report and Literature Review
Abstract
:1. Introduction
2. Case Report
3. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Day of Hospitalization | Respiratory Status | Pulmonary Changes | Lab Data | Medication Dosages | Other Clinical Data |
---|---|---|---|---|---|
1 | Tachypnoeic in VMK, FiO2 50%. shifted to HFNC 60 lpm-100%, | Basal consolidation right lung. | pH 7.48, pCO2 27, pO2 75, lactate 3.6 WBC 4000 cells/mmc CRP: 516,600 mg/L | Merrem 1 g × 3, Linezolid 600 mg × 2, Azithromycin 500 mg. | Diarrhea, consolidation on chest X-ray, initiated oxygen therapy. |
2 | HFNC 60 lpm, FiO2 80%. | Bilateral opacities. | pH 7.45, pCO2 33, pO2 247, lactate 3.2, P/F 274 | Targosid (replaced Linezolid), Cancidas 50 mg/die Aerosol therapy (Fluibron + Broncovaleas). | PASI: 0. |
3 | HFNC 60 lpm, FiO2 80%. | Stable. | pH 7.43 pCO2 38, pO2 193, Lac 1.5, P/F 276 CRP: 345,000 mg/L | Levoxacin 750 mg/die. | H. Influentiae in blood cultures. |
5 | HFNC 60 lpm, FiO2 100%. | pH 7.42 pO2 177, pCO2 36, Lac 1.1 CRP 272,000 WBC 12.000 cells/mmc | Ongoing with same treatment. | ||
6 | HFNC 60 lpm, FiO2 90% Started NIV cycles (PS 10, PEEP 8, FiO2 90%). | pH 7.41 pO2 101, pCO2 34, Lac 1.1, P/F 112 WBC 16,200 cells/mmc | Sterile placement of CVC in the right internal jugular vein with Seldinger-guided ultrasound technique, smooth procedure. Chest X-ray for control. | ||
7 | HFNC 60 lpm, FiO2 90% Placed CPAP helmet PEEP 8 at 100% FiO2 for a two-hour cycle, twice a day. | Chest X-ray unchanged. | Ph 7.46 pO2 90, pCO2 38, Lac 1.6, P/F 100 | Blood cultures performed on febrile spike. | |
8 | Eupnoic in HFNC 60 lpm FiO2 95%. NIV initiated for the night (Ps 8 Peep 8 FiO2 90%). | Mild clearing of hypodiaphania in the right middle-basal area. | pH 7.48, pCO2 37, pO2 87, lactate 1.5, P/F 92 | Linezolid added after consulting infectious disease specialist. | Thoracentesis with aspiration of 1500 cc sierous fluid; microbiological tests performed. |
9 | Eupnoic in HFNC 60 lpm-100%. NIV-Helmet PS 12 PEEP 8 FiO2 100%. | Chest X-ray unchanged. | pH 7.48, pCO2 42, pO2 89, Lac 1.5 | Clexane 8000 UI sc a day. | |
10 | Tachypnoeic in NIV helmet (Ps 12 PEEP 8 FiO2 90%), increased Ps to 14. Switched to HFNC 60 L/min, FiO2 100%. NIV helmet applied (Ps 16 PEEP 8 FiO2 100%). | pH 7.42, pO2 191, pCO2 49, Lac 1.5, P/F 191 pH 7.42, pCO2 49, pO2 105, lactate 1.7 pH 7.40, pO2 69, pCO2 50, Lac 1.7 WBC and PCR slightly reduced | |||
11 | Tachypneic in NIV helmet (PS 16, PEEP 8, FiO2 100). Intubation performed with videolaryngoscope (8 mm tube); connected to ventilator in SIMV mode Vt 550 mL RR 16 PEEP 10 FiO2 80%. | Chest X-ray control. | pH 7.42, pCO2 52, pO2 164, LAC 1.6, P/F 164 pH 7.40, pO2 122, pCO2 37, Lac 1.2, P/F 244 | Sedation with propofol and disufen, noradrenaline (IC: 14 mL/h). | Deterioration of clinical status; performed FBS, sent BAL samples to microbiology and virology. |
12 | Critical condition. Intubated and ventilated in SIMV (Vt 500 RR 16 PEEP 10 FiO2 80%) ECMO VV started (2320 rpm, BF 3, FGF 4, FiDO2 100%). | Chest/abdomen CT scan performed. | pH 7.43 pCO2 53 pO2 79 LAC 2.4 P/F 99 pH 7.50 pCO2 42 pO2 88 lactate 2.9 pH 7.40, pCO2 53, pO2 158, lactates 2.2 | Hemodynamics supported by noradrenaline in IC at 10 mL/h (4 mg:50 mL SF). Bactrim added to therapy. | |
13 | Ventilated in SIMV (VT 330, RR 10, PEEP 8, FiO2 100) with vvECMO (BF 3, FGF 4, FiDO2 100). | Chest X-ray FBS control. | EGA: pH 7.47, PaCO2 54, PaO2 84, Lactate 2.9 | Propofol, sufentanil, midazolam, noradrenaline, Amiodarone, Furosemide, ATIII, Heparin, PFC. | Hemodynamically unstable. |
14 | Ventilated in SIMV (VT 330, RR 10, PEEP 8, FiO2 80) with vvECMO (BF 3, FGF 3, FiDO2 100). Increased BF to 3.5 L/min. | Chest X-ray shows persistent bilateral parenchymal opacities. | pH 7.47, pCO2 57, pO2 80, Lac 3.2. pH 7.52, pCO2 46, P/F 78, Lac 3.4, HCO3 35 | Hemodynamically supported with noradrenaline 0.35 mcg/kg/min (increased overnight 0.42 mcg/kg/min. Corrected antithrombin. Ongoing heparin infusion at 1.9 mL/h. | |
15 | Intubated and connected to VM in SIMV (VT 330, RR 10, PEEP 8, FiO2 80, Pplat 20, Cd 21) with vvECMO (BF 3, FGF 3.5, FiDO2 100). | pH 7.46, pO2 89, pCO2 57, Lac 3.3, | |||
16 | vvECMO continued (2465 RPM BF 3.25 FGF 3 FiDO2 100%). | FBS performed, abundant collose secretions aspirated from both hemispheres. Chest X-ray unchanged. | pH 7.41, paCO2 56, paO2 98, Lac 2.9, CRP 98,600, WBC 10,280 cells/mmc | Solumedrol 1 g/day for 3 days after immunological consult. Hemodynamically supported by noradrenaline in ICU at 3 mL/h of 4 mg in SF 50 mL mcg/kg/min. | sinus bradycardia at a medium frequency of 48 bpm. Immunological consult. |
20 | vvECMO continued (2465 RPM BF 3.25 FGF 3 FiDO2 100%). | Solumedrol 80 mg/day. | PASI: 7. | ||
24 | ECMO support removed; Ventilation modified: TV 600 mL, RR 12, PEEP 8, FiO2 60%. | pH 7.44, pCO2 61, pO2 94, lactate 1.7, P/F 157. pH 7.50, pCO2 50, pO2 107, lactate 1.7, P/F 214 | Noradrenaline in ICU at 5 mL/h (4 mg:50 mL SF). Solumedrol 60 mg/day. | ||
26 | After curarization, under fibrobronchoscopic view, percutaneous tracheostomy is performed using the Griggs technique, placing a size 8 cannula, FBS is performed: thick secretions are aspirated (right > left). | Chest CT performed. | pH 7.56; pCO2 48, pO2 105, lactate 1.3; Hb 9.7, P/F 210, WBC 20,620 cells/mmc | Sedation suspended. | |
30 | Tracheostomized and ventilated in PSV (PS 14, PEEP 5, FiO2 40%). Placement of HFOT started at 60 lpm, gradually reduced to 40%. | pH 7.51, pCO2 45, pO2 115, lactate 1.6, P/F 288. WBC 19,890 cells/mmc | Valsartan 160 mg reintroduced in therapy. | PASI 13. | |
44 | pH 7.45, paO2 97, paCO2 36, Lac 1.1 | PASI 16 Patient discharged. |
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Cioffi, V.; Di Napoli, G.; Tozzi, P.; Martelli, S.; Bruno, K.; Longo, A.; Buso, H.; Pugliese, F.; Milito, C. Non-Infectious Pneumonitis and Acute Respiratory Distress Syndrome in a Patient on Ustekinumab Treatment: Case Report and Literature Review. Life 2024, 14, 394. https://doi.org/10.3390/life14030394
Cioffi V, Di Napoli G, Tozzi P, Martelli S, Bruno K, Longo A, Buso H, Pugliese F, Milito C. Non-Infectious Pneumonitis and Acute Respiratory Distress Syndrome in a Patient on Ustekinumab Treatment: Case Report and Literature Review. Life. 2024; 14(3):394. https://doi.org/10.3390/life14030394
Chicago/Turabian StyleCioffi, Valentina, Giulia Di Napoli, Pierfrancesco Tozzi, Sabina Martelli, Katia Bruno, Andrea Longo, Helena Buso, Francesco Pugliese, and Cinzia Milito. 2024. "Non-Infectious Pneumonitis and Acute Respiratory Distress Syndrome in a Patient on Ustekinumab Treatment: Case Report and Literature Review" Life 14, no. 3: 394. https://doi.org/10.3390/life14030394