Two 59-year-old male patients with COVID-19 pneumonia developed pulmonary cavitation with air-fluid level, accompanied by right-sided chest pain several weeks after first onset of symptoms. Considering a possible bacterial abscess formation, both patients were started on antibiotics. No microbiological pathogen was detected in further investigations (sputum analysis, bronchoscopy with bronchoalveolar lavage and CT-guided drainage of the cavitation). Histopathological analysis of the drained fluid was non-specific, and the aetiology remained not fully understood. We report pulmonary cavitation as a rare finding in late stage COVID-19 pneumonia. As both our patients presented with localised chest pain prior to detection of the lesions, new onset of this symptom should warrant further investigation.
Introduction/Aims Prognostic factors in Duchenne muscular dystrophy (DMD) predict the disease course and may help individualize patient care. The aim was to summarize the evidence on prognostic factors that may support treatment decisions. Methods We searched six databases for prospective studies that each included ≥50 DMD patients with a minimum follow‐up of 1 y. Primary outcomes were age at loss of ambulation (LoA), pulmonary function (forced vital capacity percent of predicted, FVC%p), and heart failure. Results Out of 5074 references, 59 studies were analyzed. Corticosteroid use was associated with a delayed LoA (pooled effect hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.23–0.75, I2 94%), better pulmonary function tests (higher peak FVC%, prolonged time with FVC%p > 50%, and reduced need for assisted ventilation) and delayed cardiomyopathy. Longer corticosteroid treatment was associated with later LoA (>1 y compared to <1 y; pooled HR: 0.50, 95% CI 0.27–0.90) and early treatment start (aged <5 y) may be associated with early cardiomyopathy and higher fracture risk. Genotype appeared to be an independent driver of LoA in some studies. Higher baseline physical function tests (e.g., 6‐minute walk test) were associated with delayed LoA. Left ventricular dysfunction and FVC <1 L increased and the use of angiotensin‐converting enzyme (ACE) inhibitors reduced the risk of heart failure and death. Fusion surgery in scoliosis may potentially preserve pulmonary function. Discussion Prognostic factors that may inform clinical decisions include age at corticosteroid treatment initiation and treatment duration, ACE‐inhibitor use, baseline physical function tests, pulmonary function, and cardiac dysfunction.
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