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Boulu X, Karam JD, Dernoncourt A, Duhaut P, Schmidt J. [Platypnea-orthodeoxia syndrome secondary to pneumonia: Two cases]. Rev Med Interne 2023; 44:143-145. [PMID: 36681524 DOI: 10.1016/j.revmed.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism. OBSERVATIONS We report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound. CONCLUSION This syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.
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Affiliation(s)
- X Boulu
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France.
| | - J D Karam
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - A Dernoncourt
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - P Duhaut
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - J Schmidt
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
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Leong A, Fong W. Factors associated with cytomegalovirus infection in antineutrophil cytoplasmic antibody-associated vasculitis: A narrative review. Int J Rheum Dis 2022; 25:1357-1367. [PMID: 36135777 DOI: 10.1111/1756-185x.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
Patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are vulnerable to opportunistic infections, including cytomegalovirus (CMV) infection. This narrative review aims to identify factors associated with CMV infection in patients with AAV. The literature review was conducted on Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, PubMed, Scopus, and Web of Science. The start date of the literature search was unrestricted and the end date was February 2022. CMV infection was defined as (a) CMV pp65 antigenemia or positive CMV DNA viral load by polymerase chain reaction or CMV detection on histological specimens, with associated signs and symptoms compatible with CMV infection; (b) presence of CMV clinical syndrome (defined as presence of compatible symptoms and signs and documentation of CMV by biopsy by virus isolation, rapid culture, immunohistochemistry, or DNA in biopsy material as defined by the CMV Drug Development Forum); and (c) CMV infection as coded by the International Statistical Classification of Diseases and Related Health Problems, 10th revision with at least one prescription for CMV treatment. We identified 4505 articles, of which three (2327 patients with AAV) were included. All studies were retrospective and only one of the three studies included only patients with AAV. Low or decreasing lymphocyte counts and higher prednisolone usage were associated with CMV infection in patients with AAV. Patients with AAV with lymphopenia and on high doses of prednisolone should be monitored closely for signs and symptoms of CMV infection, and might benefit from CMV prophylaxis. Prospective studies are urgently needed to better identify causes of CMV infections in patients with AAV.
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Affiliation(s)
- Ashley Leong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Platypnea-orthodeoxia syndrome in COVID-19: rare, not uncommon. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [PMCID: PMC9081664 DOI: 10.1186/s43168-022-00124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractCOVID-19 is a contagious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As humanity continues to fight this virus, it keeps presenting with new manifestations and complications. Platypnea-orthodeoxia syndrome (POS) is a rare clinical syndrome characterized by dyspnea and oxygen desaturation, in the supine to sitting position, which resolves with recumbency and can be diagnosed with a simple pulse oximeter. We report three cases of COVID-19 pneumonia, who developed POS during the recovery phase, in the absence of pulmonary hypertension.
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Bhushan D, Kumar V, Sahoo BH, Hegde A. Platypnea-orthodeoxia Syndrome: An Important Cause of Morbidity in Post Coronavirus Disease Patients. Indian J Crit Care Med 2022; 26:401-402. [PMID: 35519923 PMCID: PMC9015920 DOI: 10.5005/jp-journals-10071-24126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Platypnea-orthdeoxia syndrome (POS) is a clinical scenario where patient get breathless while sitting or standing. Its important causes are cardiac shunts, hepatopulmonary syndrome and pulmonary ventilation perfusion mismatch. During this pandemic as cases of pulmonary fibrosis increased, we find POS as one of the important cause of morbidity during recovery. Early recognition of this will decrease the morbidity and unrealistic expectation of fast recovery.
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Affiliation(s)
- Divendu Bhushan
- Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
- Divendu Bhushan, Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India, Phone: +91 9661216010, e-mail:
| | - Vijay Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - B Hilbert Sahoo
- Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Aniketh Hegde
- Department of General Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Tarrasó Castillo J, Posadas Blázquez TJ, Lahosa Córdoba C, Signes-Costa J. COVID-19: New disease, new manifestations. Arch Bronconeumol 2020; 56:825-826. [PMID: 32843200 PMCID: PMC7381933 DOI: 10.1016/j.arbres.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Jaime Signes-Costa
- Servicio de Neumología, Hospital Clínico Universitario INCLIVA, Valencia, España
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Mathew U, Mittal A, Vyas S, Ray A. Interstitial pneumonia with autoimmune features and platypnea-orthopnea syndrome. BMJ Case Rep 2019; 12:12/9/e230948. [PMID: 31494587 DOI: 10.1136/bcr-2019-230948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Interstitial pneumonia with autoimmune features (IPAF) is a recently proposed terminology for interstitial lung disease (ILD) with evidence of autoimmunity that does not meet the criteria for a defined connective tissue disease (CTD). Although ILD is well recognised in patients with established CTD, it is rarely the sole presenting feature of CTD. We report a case of 22-year-old male patient, who presented with progressive shortness of breath for 2 months and had features suggestive of platypnea-orthodeoxia syndrome (POS). Imaging revealed ILD with usual interstitial pneumonia pattern. Patient had features of autoimmune disorder but did not fulfil the criteria for any CTD and hence was labelled as IPAF. His POS was attributed predominantly to the lower lobe disease. The patient responded well to immunosuppressive treatment. A systematic review of literature of all cases with POS due to pulmonary parenchymal involvement has also been done.
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Affiliation(s)
- Uthara Mathew
- Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Medicine, All India Institute of Medical Sciences, New Delhi, India
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Swapna R, Roshan R, Chhabra SK. Platypnea-orthodeoxia syndrome in idiopathic pulmonary fibrosis with Pneumocystis jiroveci pneumonia. Lung India 2017; 34:372-375. [PMID: 28671170 PMCID: PMC5504896 DOI: 10.4103/0970-2113.209236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Platypnea-orthodeoxia syndrome (POS), the occurrence of dyspnea and arterial desaturation on changing from supine to sitting position, is a very rare phenomenon. Most case reports have been in association with an intra-atrial communication, and observation of this unusual physiological abnormality in pulmonary conditions has been extremely rare. We present a case of idiopathic pulmonary fibrosis where the patient developed characteristic symptoms of POS when it was complicated by Pneumocystis jiroveci pneumonia. This was objectively confirmed. A similar association has not been reported earlier in literature.
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Affiliation(s)
- R Swapna
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
| | - Rahul Roshan
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
| | - Sunil K Chhabra
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
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Hyun Sung J, Uojima H, Branch J, Miyazono S, Kitagawa I, Kako M, Kobayashi S. Platypnea-orthodeoxia Syndrome Induced by an Infected Giant Hepatic Cyst. Intern Med 2017; 56:2019-2024. [PMID: 28768974 PMCID: PMC5577080 DOI: 10.2169/internalmedicine.56.8004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An 83-year-old man was admitted with a chief complaint of exacerbation of dyspnea. His blood oxygen saturation was 90% in the recumbent position despite oxygen therapy, and it dropped to less than 80% when the patient attempted to sit upright. A computed tomography scan revealed a giant hepatic cyst compressing the right atrium and the inferior vena cava. After percutaneous drainage, the oxygen saturation improved and did not change with alteration of the patient's positions from recumbent to sitting or standing. This case report describes a patient with the platypnea-orthodeoxia syndrome due to a giant hepatic cyst successfully managed by percutaneous drainage.
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Affiliation(s)
- Ji Hyun Sung
- Department of Hepatobiliary Medicine, Shonan Kamakura General Hospital, Japan
| | - Haruki Uojima
- Department of Hepatobiliary Medicine, Shonan Kamakura General Hospital, Japan
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Joel Branch
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Sho Miyazono
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Makoto Kako
- Department of Hepatobiliary Medicine, Shonan Kamakura General Hospital, Japan
| | - Shuzo Kobayashi
- Department of Nephrology and Dialysis Medicine, Shonan Kamakura General Hospital, Japan
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Platypnea-Orthodeoxia Syndrome: Multiple Pathophysiological Interpretations of a Clinical Picture Primarily Consisting of Orthostatic Dyspnea. J Clin Med 2016; 5:jcm5100085. [PMID: 27669319 PMCID: PMC5086587 DOI: 10.3390/jcm5100085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/08/2016] [Accepted: 09/21/2016] [Indexed: 12/31/2022] Open
Abstract
Platypnea–orthodexia syndrome (POS) is often a challenging diagnostic problem. It is characterized by dyspnea that is accentuated by standing or sitting positions due to a marked fall in blood oxygen saturation, and instead is improved by assuming the lying position. In the present brief review, the authors address the pathophysiology of POS, and outline its clinical symptoms as well as the main modalities of diagnostic evaluation and possible therapeutic options. Moreover, some problems concerning much-debated issues and persistent uncertainties about the pathophysiology of POS are presented along with the description of the diagnostic and therapeutic resources currently available for this syndrome.
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Platypnea-orthodeoxia syndrome : Orthostatic dyspnea and possible pathophysiological substrates. Herz 2016; 42:384-389. [PMID: 27622245 DOI: 10.1007/s00059-016-4479-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/07/2016] [Indexed: 01/25/2023]
Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare disorder characterized by the emergence of a right-to-left shunt at the intracardiac or intrapulmonary level. The clinical picture is distinguished by shortness of breath that worsens on standing due to an accentuation of oxygen desaturation, and instead improves, at least partly, in the recumbent position. In this article we present a brief review of the pathophysiology of POS, as well as its clinical picture, diagnostic assessment, and preferential therapeutic options. Pathophysiological issues that are still not completely understood or much debated are outlined. The currently accepted pathophysiological concepts are presented and a summary of the main diagnostic and therapeutic tools is provided.
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Reversible Platypnea–Orthodeoxia Syndrome from Ventilation–Perfusion Mismatch in Interstitial Lung Disease: A Novel Etiology. Ann Am Thorac Soc 2016; 13:137-8. [DOI: 10.1513/annalsats.201509-643le] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mojadidi MK, Gevorgyan R, Noureddin N, Tobis JM. The effect of patent foramen ovale closure in patients with platypnea-orthodeoxia syndrome. Catheter Cardiovasc Interv 2015; 86:701-7. [DOI: 10.1002/ccd.25953] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/15/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mohammad Khalid Mojadidi
- Department of Internal Medicine; Albert Einstein College of Medicine; Jacobi Medical Center; New York
| | - Rubine Gevorgyan
- Program in Interventional Cardiology; Division of Cardiology; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California
| | - Nabil Noureddin
- Program in Interventional Cardiology; Division of Cardiology; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California
| | - Jonathan M. Tobis
- Program in Interventional Cardiology; Division of Cardiology; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California
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Takhar R, Biswas R, Arora A, Jain V. Platypnoea-orthodeoxia syndrome: novel cause for a known condition. BMJ Case Rep 2014; 2014:bcr-2013-201284. [PMID: 24717854 DOI: 10.1136/bcr-2013-201284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 50-year-old man presented with dyspnoea while sitting, standing and walking but resolved completely in supine position. On cardiorespiratory examinations, fine crackles were noted over bibasal area. Chest X-ray showed bilateral reticulonodular shadows, restrictive pattern on spirometry, elevated alveolar arterial O2 gradient on arterial blood gas. High-resolution CT of the thorax revealed pattern as 'confident' or 'certain' radiographic diagnosis of idiopathic pulmonary fibrosis (IPF). Bubble-contrast echocardiography in recumbent, sitting and upright positions revealed no intracardiac (right to left shunt) or intrapulmonary shunts. This case highlights the necessity of awareness of this syndrome in cases of interstitial lung diseases (ILDs) also. Although 188 cases have been described thus far of platypnoea-orthodeoxia syndrome (P-OS) of various aetiologies, to the best of our knowledge, it is the first ever case of P-OS in ILD/IPF. Both lung bases were predominantly affected in this patient, platypnoea and orthodeoxia were attributed to areas of low/zero ventilation/perfusion (V/Q) ratio (zone 1 phenomena) as no other obvious explanation was found.
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Affiliation(s)
- Rajendra Takhar
- Department of Pulmonary Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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Ali OM, Agarwal A, Akram S. Platypnea orthodeoxia: a 'laid-back' case of dyspnoea. BMJ Case Rep 2013; 2013:bcr-2012-007810. [PMID: 23362060 DOI: 10.1136/bcr-2012-007810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man with end-stage liver disease who presented with shortness of breath. He exhibited clinical platypnea (worsening shortness of breath on sitting up) and orthodeoxia (oxygen desaturation on sitting up). Follow-up investigations led to the diagnosis of hepatopulmonary syndrome.
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Affiliation(s)
- Omair M Ali
- Department of Internal Medicine, Wright State University, Dayton, Ohio, USA.
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Platypnea-Orthodeoxia: Bilateral Lower-Lobe Pulmonary Emboli and Review of Associated Pathophysiology and Management. South Med J 2011; 104:215-21. [DOI: 10.1097/smj.0b013e31820bfb54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saeed G. Should patent foramen ovale be closed in patients with recent cryptogenic stroke or presumptive platypnea-orthodeoxia syndrome? Tex Heart Inst J 2011; 38:214-215. [PMID: 21494544 PMCID: PMC3066803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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