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array:23 [ "pii" => "S0300289623001849" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.05.019" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "3337" "copyright" => "SEPAR" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2023;59:591-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289623001862" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.06.005" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "3339" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2023;59:593-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Necrotizing Pneumonia Due to Dialister Pneumosintes" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "593" "paginaFinal" => "594" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1308 "Ancho" => 1740 "Tamanyo" => 301576 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT pulmonary angiogram. Extensive consolidation that occupies the entire left lower lobe with two cavitations inside with air-fluid level, the largest of 7<span class="elsevierStyleHsp" style=""></span>cm, suggesting necrotizing pneumonia with lung abscesses (A and B). Complete resolution of the pneumonic process visualizing in its place an area with fibro-atelectatic changes as a residual finding (C and D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Romero López, Juan José Maya González, Roberto del Pozo Rivas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Javier Romero" "apellidos" => "López" ] 1 => array:2 [ "nombre" => "Juan José Maya" "apellidos" => "González" ] 2 => array:2 [ "nombre" => "Roberto del Pozo" "apellidos" => "Rivas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001862?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000009/v2_202311210635/S0300289623001862/v2_202311210635/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289623001801" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.06.004" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "3335" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2023;59:589-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Uncommon Presentation of COVID-19: XBL Variant" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "589" "paginaFinal" => "590" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1160 "Ancho" => 1650 "Tamanyo" => 238363 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jing Zhang, Peixin Dong, Baomo Liu, Shuaishuai Wang, Yan Su, Xiongye Xu, Jiating Deng, Ziying Lin, Shaoli Li, Jincui Gu, Yanli Qiu, Lixia Huang, Yanbin Zhou" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Jing" "apellidos" => "Zhang" ] 1 => array:2 [ "nombre" => "Peixin" "apellidos" => "Dong" ] 2 => array:2 [ "nombre" => "Baomo" "apellidos" => "Liu" ] 3 => array:2 [ "nombre" => "Shuaishuai" "apellidos" => "Wang" ] 4 => array:2 [ "nombre" => "Yan" "apellidos" => "Su" ] 5 => array:2 [ "nombre" => "Xiongye" "apellidos" => "Xu" ] 6 => array:2 [ "nombre" => "Jiating" "apellidos" => "Deng" ] 7 => array:2 [ "nombre" => "Ziying" "apellidos" => "Lin" ] 8 => array:2 [ "nombre" => "Shaoli" "apellidos" => "Li" ] 9 => array:2 [ "nombre" => "Jincui" "apellidos" => "Gu" ] 10 => array:2 [ "nombre" => "Yanli" "apellidos" => "Qiu" ] 11 => array:2 [ "nombre" => "Lixia" "apellidos" => "Huang" ] 12 => array:2 [ "nombre" => "Yanbin" "apellidos" => "Zhou" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001801?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000009/v2_202311210635/S0300289623001801/v2_202311210635/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Severe COVID-19 Pneumonia and Delayed Bilateral Vocal Cord Paralysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "591" "paginaFinal" => "592" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Anna Torrente-Nieto, Manel Haro-Estarriol, Eric Rojas-Calvera" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Anna" "apellidos" => "Torrente-Nieto" "email" => array:1 [ 0 => "atorrente.girona.ics@gencat.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Manel" "apellidos" => "Haro-Estarriol" ] 2 => array:2 [ "nombre" => "Eric" "apellidos" => "Rojas-Calvera" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología, Hospital Universitario Trueta de Gerona, Hospital Santa Caterina de Salt e Instituto de Investigación Biomédica de Gerona (IDIBGI), Gerona, Catalonia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronavirus disease 2019 (COVID-19) can cause severe acute respiratory distress (ARDS) and long-term complications.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We report a case of delayed bilateral vocal cord paralysis (BVCP) as an exceptional complication of severe COVID-19 pneumonia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 41-year-old patient was admitted for severe ARDS caused by bilateral SARS-CoV-2 pneumonia that required orotracheal intubation for 6 days. The patient was extubated, but reintubation was required for laryngeal edema that was treated with corticosteroids, following which he was successfully extubated. Fiberoptic laryngoscopy showed mild laryngeal edema and vocal cord pathology was ruled out. Seventy-six days after discharge, the patient consulted for progressive dysphonia and inspiratory stridor, so corticosteroid treatment was started. Respiratory function tests showed amputated flow/volume curves. Fiberoptic laryngoscopy was repeated, confirming complete paralysis of both vocal cords. A subsequent neck and chest CT scan ruled out other lesions, so we opted for speech therapy and respiratory physiotherapy that resulted in clinical improvement.</p><p id="par0015" class="elsevierStylePara elsevierViewall">BVCP has a broad etiology: surgery, cancer, and neurological disorders are the most common causes, while intubation and viral infection are much more infrequent.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Up to 50% of cases are classified as idiopathic but may conceal a viral etiology.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Vocal cord involvement has been reported in several viral diseases. Influenza A,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> for example, has been associated with delayed postviral vagal neuropathy at 22 weeks and a good prognosis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The absence of other possible causes and the timeframe of the case suggested a viral etiology. Severe SARS-CoV-2 infection can cause delayed cranial nerve changes<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and there is evidence of the neuroinvasive potential of the virus, possibly as a result of direct neurotoxicity mediated by ACE-2 receptors that allow access to the central nervous system (CNS).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Once the virus has accessed the CNS it is difficult to eliminate due to the absence of major histocompatibility complex antigens and the homeostatic characteristics of the CNS cells.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> This situation, along with a progressive inflammatory cascade and persistent immune hyperreactivity, could affect various cranial and peripheral nerves that, due to their more caudal location, would account for delayed involvement in a very limited number of cases.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> Furthermore, retrograde transport of SARS-CoV-2 along the vagus nerve to the brainstem causing delayed BVCP has been mooted.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The real incidence of BVCP caused by SARS-CoV-2 is unknown, but it is clearly very rare.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The few reported cases involved a serious event that appeared 3–40 days after discharge, although in our case, BVCP developed even later.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">–</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The possibility of BVCP in the late stages of a serious SARS-CoV-2 infection must be recognized to facilitate prompt diagnosis and treatment of this potentially life-threatening condition. It can be diagnosed by assessing patient background, clinical history, respiratory function tests, and direct endoscopic images, and appropriate treatment must be administered in line with severity and clinical impact.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 190207 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short and long-term impact of COVID-19 infection on previous respiratory diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. 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