Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids

Filho, Cilomar Martins de Oliveira; Vieceli, Tarsila; Bassotto, Caroline de Fraga; Barbato, João Pedro da Rosa; Garcia, Tiago Severo; Scheffel, Rafael Selbach

doi:10.1016/j.bjid.2021.101541

Cited by 27 publications

(32 citation statements)

References 9 publications

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“…Increased corticosteroid doses and treatment duration beyond the usual 10-day course are both recommended to establish remission and avoid relapse. Consistent evidence supports examining secondary OP in persons with past COVID-19 infection who have clinical and radiographic deterioration following recent cessation of corticosteroids, in the absence of evidence of new infection or other causation [ 3 , 11 ]. Secondary OP was a strong possibility in our patient.…”

Section: Discussionmentioning

confidence: 93%

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

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Phan

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 93%

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

Tran

Phan

et al. 2022

Am J Case Rep

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“…Organizing pneumonia, which presents with CT findings of peripheral consolidation, reticulations, and ground-glass infiltrates, has also been reported to complicate the course of COVID-19 patients in 12.5% of cases [ 30 – 32 ]. The diagnosis of organizing pneumonia requires tissue biopsy and is characterized by patchy alveolar and bronchial filling by loose connective tissue on histologic evaluation [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Function and Chest Computed Tomography (CT) Scan Findings After Antifibrotic Treatment for COVID-19-Related Pulmonary Fibrosis

et al. 2022

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Patient: Female, 51-year-old Final Diagnosis: COVID-19 pneumonia • severe • recovered Symptoms: Cough Medication: — Clinical Procedure: None Specialty: Pulmonology Objective: Unusual setting of medical care Background: Physicians worldwide have been reporting many cases of COVID-19-induced pulmonary fibrosis. We report the case of a 51-year-old Filipino asthmatic woman who developed post-COVID-19 pulmonary fibrosis subsequently treated with Nintedanib. Case Report: The patient presented with a 4-day history of flu-like symptoms in September 2020 and was eventually diagnosed with severe COVID-19 pneumonia. Despite receiving Dexamethasone, Tocilizumab, Remdesivir, and multiple antibiotics, there was increasing oxygen requirement, necessitating ICU admission and high-flow nasal cannula (HFNC). An additional course of hydrocortisone was given due to asthma exacerbation, gradually liberating her from the HFNC. A chest CT scan showed extensive parenchymal changes, for which she received methylprednisolone and physical rehabilitation with persistence of respiratory symptoms. After 40 days of hospitalization, she was sent home on oxygen support and Nintedanib. The patient initially had severe dyspnea (Borg Scale 7) with 6-minute walk distance (6MWD) of 295 meters. Pulmonary function showed moderately severe restrictive lung defect at 52% predicted total lung capacity (TLC) and severely reduced DLCO (28% predicted). Chest CT scoring indicated severe lung involvement. One month after Nintedanib treatment, her Borg Scale improved to 4. Her 6MWD, TLC, and DLCO increased to 434 meters, 64% predicted, and 36% predicted, respectively. A chest CT scan showed regressing fibrosis. After 6 months of treatment, her pulmonary function normalized. DLCO remained moderately reduced (59% predicted) but her 6MWD (457 meters) and CT scan results continued to improve. Conclusions: Nintedanib, along with other interventions, may have potentially improved pulmonary function and CT scan findings in a COVID-19 survivor with pulmonary fibrosis 6 months after treatment.

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“…Estudios anteriores han sugerido que algunos pacientes con COVID-19 pueden desarrollar neumonía organizativa secundaria (NO) [ 13 , 14 , 15 ]. La NO se define como un exudado organizativo intraalveolar compuesto por fibroblastos y miofibroblastos [ 16 ].…”

Section: Discussionunclassified

Reporte de caso: Papel potencial de los corticosteroides en el tratamiento de la neumonía post-COVID-19

et al. 2022

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Tras recuperarse de una neumonía grave debida a la enfermedad por coronavirus 2019 (COVID-19), algunos pacientes permanecen sintomáticos en el periodo posinfeccioso, ya sea de manera clínica, radiológica o respiratoria. El periodo post-COVID-19 se caracteriza por síntomas clínicos cuya duración varía de un sujeto a otro y no parece depender de la gravedad de la neumonía inicial. Las reacciones inflamatorias o inmunitarias persistentes en el periodo post-COVID-19 pueden desempeñar un papel en el desarrollo de las lesiones pulmonares. Aquí reportamos el caso de un hombre de 61 años con neumonía grave por COVID-19, complicada con síndrome de dificultad respiratoria aguda y embolia pulmonar, que requirió ingresar a la unidad de cuidados intensivos y oxigenoterapia de alto flujo. El paciente permaneció hospitalizado durante 23 días para tratar la neumonía grave por COVID-19. Posteriormente, se le envió a casa tras una prueba negativa de PCR para el SARS-CoV-2. El periodo posterior al COVID-19 se caracterizó por una sintomatología respiratoria compleja, con tos, disnea en reposo y disnea de esfuerzo que requirió oxigenoterapia durante varias semanas. Sorprendentemente, la tomografía computarizada torácica de seguimiento realizada cuatro semanas después del alta reveló lesiones pulmonares intersticiales bilaterales. Tras descartar una sobreinfección pulmonar, el paciente recibió tratamiento con corticosteroides orales durante tres meses en dosis digresiva. En nuestro caso, el uso de corticosteroides en la fase posterior al COVID-19 mejoró la enfermedad pulmonar. Estos beneficios se caracterizan por una rápida mejoría sintomática, la reparación acelerada de las imágenes pulmonares, la rápida retirada de oxígeno y un pronto retorno a las actividades cotidianas.

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Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids

Cited by 27 publications

References 9 publications

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

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

Pulmonary Function and Chest Computed Tomography (CT) Scan Findings After Antifibrotic Treatment for COVID-19-Related Pulmonary Fibrosis

Reporte de caso: Papel potencial de los corticosteroides en el tratamiento de la neumonía post-COVID-19

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