Key result
A patient with genetically confirmed pulmonary veno-occlusive disease initially showed a positive vasoreactive test and response to calcium channel blockers, but later developed severe pulmonary edema upon PAH-specific therapy escalation.
Why the study?
The rapid course of pulmonary veno-occlusive disease with high mortality highlights the need for early diagnosis and lung transplantation referral, especially in atypical clinical presentations.
Case Report (n=1)
No
A positive vasoreactive test can occur in the early stages of genetically confirmed pulmonary veno-occlusive disease, but subsequent loss of vasoreactivity and pulmonary edema upon PAH therapy escalation should prompt genetic testing and lung transplant referral.
Loss of vasoreactivity with edema on PAH escalation may signal PVOD despite initial response; this case report leaves open broader testing recommendations.
Pulmonary veno-occlusive disease (PVOD) is verified by identifying typical pathological changes in lungs or mutation in the EIF2AK4 gene. Clinical suspicion is based on combination of specific pulmonary pattern on computed tomography scan, hypoxemia with low diffusing lung capacity (DLCO) and inadequate response to specific therapy of pulmonary arterial hypertension (PAH). The rapid course of PVOD with high mortality determines the importance of early diagnosis and lung transplantation refferal. We present an unusual clinical case of 40-year-old woman with expected idiopathic PAH and extremely low DLCO with verified EIF2AK4 gene mutation, who demonstrated a positive vasoreactive test (VRT) and clinical response to calcium channel blockers therapy at the onset of the disease. The loss of positive VRT and subsequent PAH specific therapy escalation resulted in PVOD manifestation with severe desaturation, recurrent syncope and pulmonary edema. The combination of low DLCO and inadequate response to PAH therapy in idiopathic PAH patient should be of a paramount awareness of PVOD. Careful PAH therapy escalation with meticulous follow-up, pulmonary multispiral CT and genetic testing could improve early PVOD diagnostics and lung transplantation referral.
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Andreeva et al. (2023) conducted a case report in Pulmonary veno-occlusive disease (n=1). Calcium channel blockers and PAH-specific therapy was evaluated on Clinical and hemodynamic response. A patient with genetically confirmed pulmonary veno-occlusive disease initially showed a positive vasoreactive test and response to calcium channel blockers, but later developed severe pulmonary edema upon PAH-specific therapy escalation.
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