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Cleveland Clinic Journal of Medicine

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Letter to the Editor

Unilateral pulmonary edema

Abraham Joseph, MBBS, MD and Jonathan Rohde, DNP, MSN, APRN, CNP
Cleveland Clinic Journal of Medicine June 2022, 89 (6) 328; DOI: https://doi.org/10.3949/ccjm.89c.06001
Abraham Joseph
Department of Internal Medicine, Mayo Clinic Health System, Fairmont, MN
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Jonathan Rohde
Department of Internal Medicine Mayo Clinic Health System, Fairmont, MN
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To the Editor: We appreciate the article, “Unilateral pulmonary edema,” by Harano and Nakajima in the March issue (Harano Y, Nakajima M. Unilateral pulmonary edema. Cleve Clin J Med 2022; 89(3):124–125. doi:10.3949/ccjm.89a.21046).1 It was a very interesting discussion of the potential manifestations of unilateral pulmonary edema after COVID-19 infection. One key aspect we would like to bring to the discussion is to include multisystem inflammatory syndrome in adults (MIS-A) in the differential diagnosis. The evaluation includes fever at or before presentation, severe cardiac illness, rash with nonpurulent conjunctivitis, abdominal pain, vomiting, diarrhea, and thrombocytopenia. The recommended laboratory evaluation includes C-reactive protein, ferritin, interleukin-6, erythrocyte sedimentation rate, and procalcitonin.2 If indeed the patient had MIS-A, the treatment would have included steroids, intravenous immunoglobulin, and supportive care.3 The reason to include this in the differential is that the therapy required for the treatment of MIS-A is different than what was discussed. Given the emergence of MIS-A with COVID-19, healthcare providers would benefit from further discussion to ensure this diagnosis is contemplated especially in the 2 to 12 weeks after diagnosis of COVID-19. The patient presented by Harano and Nakajima met the criteria for severe cardiac illness, and further discussion regarding the above evaluation would be useful to know if this diagnosis was considered, because treatment would have included those we mentioned above.

  • Copyright © 2022 The Cleveland Clinic Foundation. All Rights Reserved.

REFERENCES

    1. Harano Y,
    2. Nakajima M
    . Unilateral pulmonary edema. Cleve Clin J Med 2022; 89(3):124–125. doi:10.3949/ccjm.89a.21046
  1. Multisystem inflammatory syndrome in adults (MIS-A) case definition information for healthcare providers. https://www.cdc.gov/mis/index.html. Accessed May 23, 2022.
    1. Ahmad F,
    2. Ahmed A,
    3. Rajendraprasad S, et al
    . Multisystem inflammatory syndrome in adults: a rare sequela of SARS-CoV-2 infection. Int J Infect Dis 2021; 108:209–211. doi.org/10.1016/j.ijid.2021.05.050

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