Rationale: Coronavirus disease 2019 (COVID-19) can cause disruption of the renin-angiotensin system in the lungs, possibly contributing to pulmonary capillary leakage. Thus, angiotensin receptor blockers (ARBs) may improve respiratory failure.Objective: Assess safety of losartan for use in respiratory failure related to COVID-19 (NCT04335123).Methods: Single arm, open label trial of losartan in those hospitalized with respiratory failure related to COVID-19. Oral losartan (25 mg daily for 3 days, then 50 mg) was administered from enrollment until day 14 or hospital discharge. A post-hoc external control group with patients who met all inclusion criteria was matched 1:1 to the treatment group using propensity scores for comparison.Measures: Primary outcome was cumulative incidence of any adverse events. Secondary, explorative endpoints included measures of respiratory failure, length of stay and vital status.Results: Of the 34 participants enrolled in the trial, 30 completed the study with a mean age SD of 53.8 ± 17.7 years and 17 males (57%). On losartan, 24/30 (80%) experienced an adverse event as opposed to 29/30 (97%) of controls, with a lower average number of adverse events on losartan relative to control (2.2 vs. 3.3). Using Poisson regression and controlling for age, sex, race, date of enrollment, disease severity at enrollment, and history of high-risk comorbidities, the incidence rate ratio of adverse events on losartan relative to control was 0.69 (95% CI: 0.49–0.97)Conclusions: Losartan appeared safe for COVID-19-related acute respiratory compromise. To assess true efficacy, randomized trials are needed.

No abstract

No abstract

A 64-year-old man with a history of rheumatoid arthritis (RA) on treatment with methotrexate 22.5 mg weekly and adalimumab 40 mg biweekly, presented to the emergency department with complaints of cough, dyspnea, and fatigue. The patient reported cough and dyspnea over the eight weeks prior to presentation. He was treated as an outpatient for cough with a course of azithromycin, then doxycycline. However, he progressively worsened over the month prior to presentation as he began to experience dyspnea on exertion.Upon presentation, the patient was afebrile with stable vital signs. He had a normal cardiopulmonary examination. His complete blood count with differential, comprehensive metabolic panel, and brain natriuretic peptide were within normal limits. A chest x-ray revealed diffuse infiltrates. A computed tomography (CTA with/without contrast pulmonary embolism protocol) of the chest was negative for pulmonary embolism, but showed diffuse five lobe alveolar infiltrates with posterior predominance. No thoracic lymphadenopathy was noted (see image above).The patient was admitted for further work-up of progressive dyspnea with failed outpatient treatment and a bronchoscopy was performed the next day. On bronchoscopy, the pharynx,

No abstract