Large pulmonary cavity in COVID-19 cured patient case report

Abstract

Coronavirus Disease 2019 (COVID-19) is a pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak began in Wuhan, China, and spread rapidly, with many cases confirmed in multiple countries. Usually, after viral pneumonia were clinical cured, the pulmonary lesions of majority patients will gradually be absorbed to complete dissipation, very few severe patients may retain pulmonary interstitial inflammation and fibrosis. In this case, we described one unique COVID-19 patient, the symptoms were: dry cough, fatigue, poor appetite and subjective fever, moreover, the patient was a non-smoker, had no pulmonary bullous, no history of tuberculosis, and also no hypertension or diabetes. The patient received antiviral therapy, antibacterial therapy, recombinant human interferon-α2a, vitamin C and oxygen inhalation. After two weeks of treatment and observation, the patient was clinical cured and discharged. However, two days later, the patient had a sudden chest stuffiness, CT images indicted: his lung didn't heal like others, but developed a large pulmonary cavity in the lower lobe of right lung. In hospital, the patient showed no symptoms of infection for another 14 days, and the pulmonary cavity remain unchanged. This case suggested: it is important to follow convalescent COVID-19 patients, especially their lung CT images, to make sure a fully recovery.

Lung cavitation-a rare complication in COVID-19 patients: A case report

“…The CT fi ndings of COVID-19 pneumonia refl ect a typical lung injury pattern seen in viral pneumonia, which is characterized by a rapid change in the imaging patterns as seen in severe acute respiratory syndrome and Middle East respiratory syndrome [1]. As known for most cured viral pneumonia, the lung lesions are gradually absorbed and dissipated, but for COVID-19 infection, the long term imaging pattern is still not known and needs further observation [2]. Lung cavitation following pulmonary embolism and lung infarction is known previously [5,6].…”

“…Usually, in clinically cured patients with viral pneumonia, the pulmonary lesions gradually resolve and show complete remission. In very few severe patients, there are residual lesions and fi brosis [2]. Since SARS-CoV-2 is a new coronavirus, the repairative process of SARS-CoV-2 infected pulmonary lesions is not well known.…”

“…Cavitation, lymphadenopathy and pleural effusion are known to occur, but are rare presentations[3]. There are cases reported in the literature of development of pulmonary cavity after bacterial infection in the late recovery stage in SARS patients[2].…”

Lung cavitation due to COVID-19 pneumonia

“…Lung cavitation due to COVID-19 pneumonia is uncommon. 5 Although the exact mechanism of cavitation in COVID-19 pneumonia is unknown, it may be related to diffuse alveolar damage, intra-alveolar haemorrhage and necrosis of parenchymal cells based on prior autopsy reports. 6 7 While most cases are self-limited and managed conservatively, as in our case, respiratory status must be monitored closely in patients with massive haemoptysis.…”

Destructive pulmonary fibrosis after severe COVID-19 pneumonia

“…Severe COVID-19 pneumonia may progress to pulmonary fibrosis ( George et al 2020 ) related to diffuse alveolar damage but the association with lung cavitation is uncommon and may significantly impair outcome ( Chen et al 2020 ).…”