2 CASE HISTORY
A 60-year-old Japanese man with no medical, family, or smoking history
was diagnosed with coronavirus disease 2019 (COVID-19). Two weeks later,
he was bought to our hospital in an ambulance because of high fever and
dyspnea. He required oxygen supplementation at 15 L/min via an oxygen
mask with an oxygen reservoir and he was immediately intubated. Computed
tomography (CT) revealed bilateral diffuse infiltrations (Fig.1A, 1B)
and he was diagnosed as having bacterial and secondary organizing
pneumonia following COVID-19 infection. He was treated with antibiotics,
methylprednisolone, and heparin sodium. His respiratory condition
improved gradually, and mechanical ventilation was discontinued on day
15. He complained of right chest pain on day 22, and CT revealed
right-sided pneumothorax. A chest drain was inserted immediately, which
was removed on day 29 after pleurodesis with minocycline (MINO) 200 mg
and OK-432 5KE. However, the right-sided pneumothorax recurred on day
50, and a left-sided pneumothorax appeared on day 56. Chest drainage was
performed on both sides, and an additional drain was placed on the right
side (Fig. 1C). He underwent pleurodesis on both sides (right side:
twice with MINO 200 mg and OK-432 5KE and twice with 100mL of autologous
blood, left side: twice with 100mL of autologous blood); however, the
air leak persisted. There were more leaks on the left side than on the
right side; therefore, we performed a bronchial occlusion procedure
using Endobronchial Watanabe Spigots®(EWS®;
Novatech, La Ciotat, France) for the left-sided pneumothorax on day 68.
We inserted a 6-mm EWS® into B8bⅰ and a 7-mm
EWS® into B8bⅱ on the left (Fig. 1D). Bronchial
occlusion procedure was performed using flexible bronchoscopes (1T290
and P290, Olympus, Tokyo, Japan) and curette (CC-4CR-1, Olympus, Tokyo,
Japan). The right lung expanded fully after bronchial occlusion and
pleurodesis with 100mL of autologous blood added on both sides,
performed once on the right side and twice on the left side. Thereafter
the air leaks on both the sides stopped, and bilateral pneumothorax
improved. The right drain was removed on day 73 and the left drain on
day 75. Thereafter, there was no recurrence of pneumothorax and he was
discharged on day 202 after rehabilitation for ICU-acquired weakness.