A Case of Rebound Inflammation in a 38-Year-Old Man with Severe COVID-19 Pneumonia Following Cessation of Dexamethasone Therapy

Abstract

Patient: Male, 38-year-old Final Diagnosis: COVID 19 infection • pneumonia Symptoms: Dyspnea • fever Medication: — Clinical Procedure: — Specialty: Cardiology • Infectious Diseases Objective: Unusual clinical course Background: Since the initial COVID-19 cases in 2019, the pandemic has expanded globally. Clinical data showed that dexamethasone treatment at a dose of 6 mg daily for up to 10 days in hospitalized patients with COVID-19 who were receiving respiratory support decreased 28-day mortality in COVID-19 patients. Recent reports, on the other hand, have indicated that both steroid resistance and rebound events occur. We report a case of rebound inflammation after the termination of dexamethasone medication in a 38-year-old man with severe COVID-19 pneumonia, which improved after the reintroduction of dexamethasone. Case Report: A 38-year-old male patient with no past medical history of note presented with new onset of dyspnea. He was subsequently diagnosed with severe coronavirus disease 2019 (COVID-19). Initially, the patient was clinically improved following a 3-day course of 16 mg of dexamethasone daily. Shortly after discontinuing corticosteroids, the patient’s clinical condition deteriorated, necessitating increased oxygen support. Following the rein-troduction of corticosteroids, the patient gradually improved and responded favorably in terms of respiratory function, symptoms, and imaging, after which he was successfully discharged. Conclusions: This case exemplifies the previously observed rebound effects of discontinuing dexamethasone medication in individuals with severe COVID-19 pneumonia. The timing and length of dexamethasone medication should be tailored to the individual patient. In addition, monitoring lung function should be part of the gradual withdrawal of dexamethasone to avoid rebound lung inflammation and the long-term effects of increasing lung fibrosis.

Late Onset of Organizing Pneumonia Following SARS-CoV-2 Infection: A Case Report of Successful Management and Review Literature

“…After 7 additional days, he was successfully discharged after having greatly improved after 2 days. 12 Our patient also experienced fever and dry cough many days after discharge, despite a negative PCR result for SARS-CoV-2. Despite this, the CT scan mostly revealed a consolidation lesion in the right lower lobe, devoid of extensive ground glass or interstitial lesions.…”

“… 9 Chest X-rays are useful for suggesting obstructive pulmonary disease (OP), while chest CT scans remain the diagnostic gold standard, with extensive ground glass lesions with bilateral reticular and consolidation lesions. 9 Tran et al 12 also described the case of a 38-year-old male diagnosed with intermediate SARS-CoV-2 infection and treated with corticosteroids for 11 days. After tapering, his dyspnea worsened and his oxygen demand increased.…”

“…In the past, highdose corticoid has proven to be an effective drug for organizing pneumonia following H1N1, H7N9, and MERS (infection with the Middle East respiratory syndrome coronavirus), with rapid clinical and radiological recovery. [19][20][21] Corticoid continues to be the first-line treatment for idiopathic organizing pneumonia 7,22 and post-COVID syndrome 9,12,13,15,23 independent of corticoid dose used in the past. 10 There are insufficient studies and data to make a firm recommendation regarding post-COVID 19 organizing pneumonia.…”

“…Recently, a number of articles on post-COVID-19 ARDS-related organizing pneumonia have been published (Table 1). [9][10][11][12][13] In a paper from Germany, 12.5% of severe COVID-19 patients were diagnosed with organizing pneumonia. Three weeks after experiencing symptoms, a chest CT scan revealed consolidation and ground glass lesions, an airbronchogram finding, pleural effusion, and thickening, according to a study conducted in China.…”