• Guofeng Ma, Dan Wang, Xiaoling Xu, Li Liang, and Li Xu.
• Regional medical center for National institute of respiratory diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
• Medicine (Baltimore). 2022 Jul 15; 101 (28): e29412e29412.

RationalePTTM is a rare but fatal disease, characterized by endothelial intimal proliferation and pulmonary hypertension due to micro-vascular remodeling. In view of the poor prognosis, new effective strategies are urgently required.Patient Concerns And DiagnosisA 51-year-old woman was admitted to hospital for acute progressive dyspnea and dry cough. Clinical tests revealed hypercoagulable state and signs of severe pulmonary hypertension, without evidence of pulmonary embolism on contrast-enhanced CT. CT showed interlobular septal thickening and diffuse ground-glass opacity. Lung perfusion scan indicated multiple segment defect. Further right heart catherization proved a significant increase in pulmonary vascular resistance.InterventionsA combination therapy of apatinib and selexipag was administered for treatment of PTTM. The conventional therapies of ventilation, anticoagulation and diuretic medicines were initiated after admission.OutcomesSymptoms of PTTM were ameliorated with a reduction in pulmonary artery pressure. The resolution of interlobular septal thickening and ground-glass opacity on CT constituted the clinical benefits from treatment.LessonsPatient with PTTM will benefit from the combination strategy of apatinib, a VEGF-receptor antagonist, and selexipag, an oral prostacyclin receptor agonist.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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