Pulmonary embolism after dexamethasone treatment for COVID-19: a case report.
Hidenori TakahashiYoshinobu IwasakiTakayasu WatanabeNaoki IchinoseToshimi OdaPublished in: BMC infectious diseases (2022)
This case illustrates the potential risk of rebound inflammation and procoagulant events following dexamethasone withdrawal. We believe that COVID-19-induced DVT and PE can be affected by dexamethasone therapy. Although dexamethasone reduces procoagulant factors, increases anticoagulant factors, and modulates cytokines, which can suppress/delay thrombus formation during treatment, it confers the risk for rebound cytokine production after treatment completion, triggering cytokine and coagulation cascades that can lead to thromboembolic diseases. In this critical clinical period, the patient's deteriorating condition may be overlooked because of the masking effects of dexamethasone treatment on fever and other clinical conditions and laboratory changes. Clinicians should follow-up coagulation markers carefully and contrast-enhanced computed tomography is useful for detecting coagulation; and, if PE occurs, therapeutic heparin administration is essential because emboli can also generate cytokines.
Keyphrases
- pulmonary embolism
- computed tomography
- contrast enhanced
- high dose
- low dose
- coronavirus disease
- magnetic resonance imaging
- sars cov
- venous thromboembolism
- magnetic resonance
- atrial fibrillation
- oxidative stress
- positron emission tomography
- diffusion weighted
- inferior vena cava
- stem cells
- palliative care
- case report
- risk assessment
- climate change
- mesenchymal stem cells
- dual energy
- respiratory syndrome coronavirus
- diffusion weighted imaging
- pet ct
- smoking cessation