Platypnea-orthodeoxia Syndrome in SARS-CoV-2 Related ARDS: a Case Report

Overview

Journal Acta Biomed

Specialty General Medicine

Date 2022 Jun 7

PMID 35671104

Authors

Concetta Aprea

Simona Imbriani

Giovanna Cirigliano

Klodian Gjeloshi

Luciana Agnese Meo

Andrea Padula

Roberta Ranieri

Carmen Ricozzi

Carolina Ruosi

Domenico Cozzolino

Luigi Elio Adinolfi

Riccardo Nevola

Affiliations

Soon will be listed here.

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.

Citing Articles

Platypnea-Orthodeoxia Syndrome and COVID-19 Successfully Treated With Percutaneous Patent Foramen Ovale Closure: A Report of Two Cases and Literature Review.

Jimenez-Segovia F, Luis-Garcia S, Gonzalez-San Narciso C, Demelo-Rodriguez P, Garcia-Martinez R, Galeano-Valle F Cureus. 2024; 16(3):e56655.

PMID: 38646276 PMC: 11032186. DOI: 10.7759/cureus.56655.

Platypnea-Orthodeoxia Syndrome in Coronavirus Disease 2019 Pneumonia: A Case Report and Literature Review.

Tanimoto T, Eriguchi Y, Sato T, Yonekawa A, Miyake N, Akashi K Int Med Case Rep J. 2023; 16:201-207.

PMID: 37007669 PMC: 10065003. DOI: 10.2147/IMCRJ.S402537.

Multiplex protein profiling of bronchial aspirates reveals disease-, mortality- and respiratory sequelae-associated signatures in critically ill patients with ARDS secondary to SARS-CoV-2 infection.

Molinero M, Gomez S, Benitez I, Vengoechea J, Gonzalez J, Polanco D Front Immunol. 2022; 13:942443.

PMID: 35967328 PMC: 9373836. DOI: 10.3389/fimmu.2022.942443.

References

Pfeifer M, Ewig S, Voshaar T, Randerath W, Bauer T, Geiseler J . Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19. Respiration. 2020; 99(6):521-542. PMC: 7360514. DOI: 10.1159/000509104. View

Herrmann J, Mori V, Bates J, Suki B . Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia. Nat Commun. 2020; 11(1):4883. PMC: 7522238. DOI: 10.1038/s41467-020-18672-6. View

Montenegro F, Unigarro L, Paredes G, Moya T, Romero A, Torres L . Acute respiratory distress syndrome (ARDS) caused by the novel coronavirus disease (COVID-19): a practical comprehensive literature review. Expert Rev Respir Med. 2020; 15(2):183-195. DOI: 10.1080/17476348.2020.1820329. View

Chang Y, Yu C, Chang S, Galvin J, Liu H, Hsiao C . Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology. 2005; 236(3):1067-75. DOI: 10.1148/radiol.2363040958. View

Fox S, Akmatbekov A, Harbert J, Li G, Brown J, Vander Heide R . Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020; 8(7):681-686. PMC: 7255143. DOI: 10.1016/S2213-2600(20)30243-5. View

Tan G, Ho S, Fan B, Chotirmall S, Tan C, Lew S . Reversible platypnea-orthodeoxia in COVID-19 acute respiratory distress syndrome survivors. Respir Physiol Neurobiol. 2020; 282:103515. PMC: 7413098. DOI: 10.1016/j.resp.2020.103515. View

Longo C, Ruffini L, Zanoni N, Longo F, Accogli R, Graziani T . Platypnea-orthodeoxia after fibrotic evolution of SARS-CoV-2 interstitial pneumonia. A case report. Acta Biomed. 2020; 91(3):ahead of print. PMC: 7716968. DOI: 10.23750/abm.v91i3.10386. View

Dodson B, Major C, Grant M, Yoo B, Goodman B . Platypnea Orthodeoxia Due to a Patent Foramen Ovale and Intrapulmonary Shunting After Severe COVID-19 Pneumonia. Am J Case Rep. 2021; 22:e933975. PMC: 8559663. DOI: 10.12659/AJCR.933975. View

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(10):002849. PMC: 8592651. DOI: 10.12890/2021_002849. View

10.

Vanhomwegen C, Taton O, Selvais N, Vanhove O, Leduc D . Patent foramen ovale revealed by COVID-19 pneumonia. BMC Pulm Med. 2021; 21(1):126. PMC: 8054231. DOI: 10.1186/s12890-021-01494-7. View

11.

Singh K, Kadnur H, Ray A, Khanna P, Singh A, Wig N . Platypnea-orthodeoxia in a patient with severe COVID-19 pneumonia. Monaldi Arch Chest Dis. 2020; 90(4). DOI: 10.4081/monaldi.2020.1609. View

12.

Tham S, Ong P, Lee A, Tay M . Rehabilitation of Patients with Platypnea-Orthodeoxia Syndrome in COVID-19 Pneumonia: Two Case Reports. J Rehabil Med Clin Commun. 2021; 3:1000044. PMC: 8054748. DOI: 10.2340/20030711-1000044. View

13.

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(5):ytab176. PMC: 8184264. DOI: 10.1093/ehjcr/ytab176. View

14.

Agrawal A, Palkar A, Talwar A . The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review. Respir Med. 2017; 129:31-38. DOI: 10.1016/j.rmed.2017.05.016. View

15.

Guerin C, Albert R, Beitler J, Gattinoni L, Jaber S, Marini J . Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020; 46(12):2385-2396. PMC: 7652705. DOI: 10.1007/s00134-020-06306-w. View

16.

Athavale T, Athavale A, Khatri V, Makhija D, Mortale M, Jaggi S . Platypnea-orthodeoxia Syndrome (POS) in Moderate COVID-19: An Uncommonly Common Bedside Sign?. J Assoc Physicians India. 2021; 69(6):11-12. View

17.

Lugara M, Oliva G, Pafundi P, Tamburrini S, Nevola R, Gjeloshi K . Clinical application of lung ultrasound score on COVID-19 setting: a regional experience in Southern Italy. Eur Rev Med Pharmacol Sci. 2021; 25(9):3623-3631. DOI: 10.26355/eurrev_202105_25846. View

18.

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(1):67. PMC: 8407127. DOI: 10.1186/s40981-021-00471-7. View

19.

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(6):e04204. PMC: 8420484. DOI: 10.1002/ccr3.4204. View

20.

Rajendram R, Kharal G, Puri R . COVID-19 May Be Exacerbated by Right-to-Left Interatrial Shunt. Ann Thorac Surg. 2020; 111(1):376. PMC: 7832762. DOI: 10.1016/j.athoracsur.2020.05.013. View