COVID-19 is a new disease with many undescribed clinical manifestations. We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient. A patient presented a severe episode of immune thrombocytopenia (< 10 × 10 9 /L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high-dose dexamethasone to observe an increase in platelet count. COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.

Background Surgical lung biopsy (SLB) is considered in the investigation of interstitial lung diseases (ILDs) when a complete clinical evaluation and a multidisciplinary discussion (MDD) do not allow the clinician to make a confident diagnosis. Owing to the risk of the procedure, an appropriate assessment of the risk/benefit ratio prior to the intervention is recommended. We aimed to assess the postoperative outcomes and diagnostic yield of SLB for the investigation of ILD in a tertiary care institution. Methods We conducted a retrospective cohort study of consecutive subjects who underwent a SLB for the investigation of ILD in our center from 2009 to 2020. The postoperative mortality and complications rates as well as the diagnostic yield of the procedure were assessed. Results Of the 1,805 patients newly investigated for ILD in our center from 2009 to 2020, 71 (3.93%) underwent a SLB. At days 30 and 90, the mortality rates were 0 and 2.8%, whereas 4.3 and 7.6% patients experienced an acute ILD exacerbation, respectively. In addition, 4 (5.8%) patients experienced infectious complications and 5 (7.0%) presented prolonged air leaks (all within 30 days). A definite pathological diagnosis was made in 47 (66.2%) patients. Following postoperative MDD, a confident diagnosis was made in 61 patients (85.9%) and resulted in a change of therapy in 49 (69.0%) patients. Conclusion SLB for the diagnosis of unclassifiable ILDs is associated with low mortality but significant morbidity. However, it results in a confident diagnosis and a change in therapy in the majority of patients.

Asbestos exposure may lead to interstitial lung diseases with radiologic findings similar to those of subjects with Idiopathic Pulmonary Fibrosis (IPF), with a Usual Interstitial Pneumonia (UIP) pattern, as well as parenchymal fibrous bands and semi-circular lines. Although asbestosis with classical patterns of UIP can lead to respiratory failure, its natural history in terms of pulmonary function is not well known. Primary objective: To compare the change in forced vital capacity (FVC) at 1 year and 4 years after diagnosis between patients with asbestosis with and without a UIP pattern. Secondary objective: To compare the change in diffusion capacity of carbon monoxide (DLCO), forced expiratory volume in one second (FEV1) and total lung capacity (TLC) at 1 and 4 years after diagnosis between patients with asbestosis with and without a UIP pattern. METHODS: We performed a retrospective cohort study of patients diagnosed with asbestosis by the Quebec Worker Compensation Board (QWCB), between January 2017 and December 2019. Patients were included if they showed an interstitial lung disease attributed to asbestos exposure and had underwent at least 2 spirometries, at baseline and at 1-or 4-year follow-up. Patients with and without UIP pattern were identified. Patients demographics, comorbidities, computed tomography findings and lung function test results were recorded. The difference in FVC between baseline, 1-year follow up and 4-year follow up was compared between the UIP-asbestosis cohort and the non-UIP-asbestosis cohort. RESULTS: Ninety nine patients were included: 40 with UIP-asbestosis, 59 with non-UIP-asbestosis. FVC decline at 1 year was 217.5ml in UIP-asbestosis vs 8.6ml in non-UIP-asbestosis (p¼0.06). FVC decline at 4 years was 396.3ml in UIP-asbestosis vs 74.8ml in non-UIP-asbestosis (p<0.001). The progression of dyspnea at 4 years in the UIP-asbestosis cohort was of 0,97 point on the MRC scale and was of 0,33 point in the non-UIP-asbestosis cohort (p¼0,003). Other pulmonary function parameters were similar between the two cohorts. CONCLUSIONS: In subjects with asbestosis, a radiological UIP pattern is associated with a greater decline in FVC over 4 years. This is similar to the unfavorable physiologic decline associated with a UIP pattern in other types of interstitial lung diseases. CLINICAL IMPLICATIONS: Recently, we have seen the clinical utility of antifibrotic agents beyond IPF, particularly in progressive fibrosing interstitial lung diseases. Therefore, by identifying patients with asbestos-related interstitial lung disease that might progress sooner, we could consider using antifibrotic agents to slow their functional decline.

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