Severe Pneumonia Caused by SARS-CoV-2: A Novel Cause of Platypnoea-Orthodeoxia Syndrome

Abstract

Platypnoea-orthodeoxia syndrome (POS) is a condition characterized by dyspnoea and hypoxaemia while sitting or standing, which improves during decubitus. It is usually caused by intracardiac right-to-left shunting through a patent foramen ovale but may also occur due to pulmonary ventilation-perfusion mismatch of other aetiologies. A new cause of POS was recently described: SARS-CoV-2 pneumonia. We report the case of a 62-year-old man admitted for SARS-CoV-2 pneumonia with respiratory failure. Chest computed tomography angiography showed pulmonary thromboembolism and parenchymal lung changes compatible with COVID-19. He had worsening dyspnoea in a sitting position, relieved by assuming the dorsal position. He was diagnosed with POS after other causes were excluded. POS is an underdiagnosed complication of COVID-19 and is manageable with respiratory rehabilitation.

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

“…Ultimately, we found 17 reports on 22 patients with POS associated with COVID-19 (Table 1). Regarding the presence of cardiac shunting, foramen ovale patency was found in three cases [5][6][7] and absent in 13 cases, [8][9][10][11][12][13][14][15][16][17][18] while no echocardiographic results were mentioned in the remaining three reports. [19][20][21] Most cases required respiratory support with high-volume oxygen, noninvasive ventilation, or invasive mechanical ventilation.…”

“…Notably, POS was more likely determined after rehabilitation following acute-phase treatment. 10,17,19 Furthermore, the prognosis for POS associated with COVID-19 was generally good, with most patients recovering within 4 to 65 days; however, three patients required long-term oxygen therapy (LTOT) after discharge. 6,8,12 One patient was re-hospitalized for worsening respiratory status 2 months after discharge home on LTOT and subsequently died from pulmonary fibrosis, pneumonia, and pneumomediastinum.…”