A 77-year-old male, ex-smoker with 40 packs/year stopped 30 years ago, with a history of hypertension, third degree atrioventricular block requiring hypothyroidism.
He had a semi-differentiated adenocarcinoma of the prostate with metastases in lung, mediastinum and bone that was treated with double maximal hormonal blockade (bicalutamide and leuprorelin) during the last year.
The patient consulted for progression of his habitual dyspnea, functional class (FC) 1 to CF4, of one week duration, associated with dry cough and feverish records, so he was hospitalized.
Physical examination revealed respiratory apremium, respiratory rate: 25 breaths/min, heart rate: 96 beats/min, blood pressure: 120/70 mm Hg, temperature 37°C and crackles in both lung bases.
The laboratory showed respiratory failure (PaO2: 56 mm Hg), without hypercapnia, hypercalcemia (Ca: 11.2 mg/dL), increased acute phase reactants and leukocytosis.
Chest tomography showed bilateral consolidations with predominance in the lower lobes and air bronchogram with ground glass areas and septal thickening.
Antibiotic treatment was initiated interpreting the picture as pneumonia associated with health care, although microbiological rescues were not obtained in hemocultive and urocultive, invasive respiratory sampling was not performed due to hemodynamic instability.
atrial fibrillation, acute pulmonary edema (APE), which led to admission to the coronary care unit where non-invasive ventilation (NIV) was initiated, and anti-cardiovascular treatment was started.
Due to lack of clinical response, right heart catheterization was performed to rule out pulmonary hypertension.
Subsequently, the patient was admitted to the intensive care unit where he received broad-spectrum empirical antibiotic treatment: vancomycin, meropenem, and non-invasive ventilation (NIV).
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Due to the progression of respiratory failure and lack of response to NIV, it required orotracheal intubation, connection to mechanical ventilation and the onset of vasopressive drugs.
She continued without improvement despite treatment with prednisone in this context of organizing pneumonia, which led to treatment with methylprednisolone 1 g/day for 5 days
The clinical picture progressed to refractory hypoxemia and continued with unfavorable evolution leading to death.
The length of hospital stay was 21 days, five of which corresponded to hospitalization in the general ward, nine in the coronary care unit and the last seven days in the intensive care unit.
The pathological analysis of the postmortem pulmonary sample revealed the presence of organizing pneumonia (OP) and usual interstitial pneumonia (UIP).
