Coronavirus disease 19 infection clinical presentation varies from asymptomatic cases to acute respiratory distress syndromes. In some cases, pulmonary fibrosis is observed after or during the disease. Pirfenidone is an agent approved for the treatment of idiopathic pulmonary fibrosis. Here we report a patient treated with pirfenidone for pulmonary fibrosis related to coronavirus disease 19.

Background and aim: Vaccinations have been one of the main approaches to reducing mortality and exacerbations caused by infectious agents in chronic obstructive pulmonary disease (COPD). Among viral pathogens, coronaviruses have been described to play a role. This study aims to investigate the role of coronavirus disease 2019 (COVID-19) vaccination on exacerbation reduction in patients with COPD.Methods: Patients diagnosed with COPD prior to the study date were considered the study population. Exacerbations of COPD before and after the COVID-19 vaccination were recorded. Patients with influenza and/or pneumococcal vaccination were excluded from the study due to their known role in reducing exacerbations of COPD.Results: The study included 152 patients with a mean age of 67.5 ± 9.7 years. Most patients were classified under Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 2 and 3. In fully vaccinated patients, COPD exacerbation was observed to be higher than in those without full vaccination (70.5% vs. 55.3%, respectively). Total risk status and vaccination status, however, were seen to be in a positive correlation, with higher risk and complete vaccination status presenting with a higher count of COPD exacerbation. Conclusion:Although it is known that the administration of COVID-19 vaccines in patients in risk groups reduces the risk of disease, there is no study showing a positive effect on COPD exacerbations alone. In our study, it was observed that only the COVID-19 vaccine was ineffective in attacks without influenza and pneumococcal vaccines.

Introduction: Idiopathic pulmonary fibrosis is a chronic progressive fibrotic lung disease of unknown etiology that occurs most commonly in older adults. The presence of pulmonary hypertension in Idiopathic pulmonary fibrosis is associated with poor prognosis and mortality. Literature suggests that the forced vital capacity to diffusion capacity of the lung for carbon monoxide ratio has a positive predictive value for the diagnosis of pulmonary hypertension. Therefore, this study aimed to investigate the impact of forced vital capacity to diffusion capacity of the lung for carbon monoxide ratio on the diagnosis of pulmonary hypertension and disease prognosis in Idiopathic pulmonary fibrosis patients. MATERIAL AND METHOD: Forty-eight patients diagnosed with Idiopathic pulmonary fibrosis were included in the study. Patient records, echocardiographic and spirometric data were retrospectively reviewed. Results: The average pulmonary arterial pressure was observed to be 32.8 (±9) mmHg, with the second-year follow-up pulmonary arterial pressure at 40.8 (±17.2) mmHg and the fourth-year follow-up pulmonary arterial pressure at 51 (±23.6) mmHg. In those diagnosed as pulmonary hypertension, the forced vital capacity to diffusion capacity of the lung for carbon monoxide ratio was initially 1.54 (±0.72). By the second year, it was 1.61 (±0.45), and by the fourth year, it was 1.87 (±0.8). It was found that the forced vital capacity to diffusion capacity of the lung for carbon monoxide ratio tended to increase when pulmonary artery pressure increased during the follow-up period. Conclusion: We found that low six- minute walking test distance was an important marker for the diagnosis of pulmonary hypertension in patients with idiopathic pulmonary fibrosis and that the presence of desaturation was also significantly associated with survival in pulmonary hypertension. Although we did not find it statistically significant, we found that both pulmonary arterial pressure and the the forced vital capacity to diffusion capacity of the lung for carbon monoxide ratio increased with progressive disease duration after diagnosis in patients with IPF. We believe that the the forced vital capacity to diffusion capacity of the lung for carbon monoxide ratio is an important marker for early detection of pulmonary hypertension and prognosis in idiopathic pulmonary fibrosis.

Introduction Tuberculosis is a significant health issue in developing countries, with the World Health Organization reporting over 10 million cases worldwide in 2014. While methods exist for rapid investigation of Mycobacterium tuberculosis, radiological imaging may lead to an earlier suspicion, such as presence of cavitation. In this case report, a patient with only radiological finding being atelectasis will be presented. Case Presentation An 18 years old female patient with no specific medical background history had been evaluated at an outpatient clinic with complaints of cough and exertional dyspnea. After a fluoroquinolone treatment for 7 days given for a pericardiac density in chest radiography, patient was admitted due to limited clinical response. A chest tomography was performed while the patient was under wide spectrum antibiotics and atelectasis in right lower lobe was observed. Repeated Acid-Fast Bacilli smears and sputum samples were found negative and bronchoscopy sampling did not show any findings of obstruction. Mycobacterium tuberculosis complex DNA was later detected in the lavage samples for which antituberculosis treatment was initiated with a regimen of isoniazid 5 mg/kg, pyrazinamide 25 mg/kg, ethambutol 15 mg/kg, and rifampin 10mg/kg. Discussion The diagnosis of tuberculosis, in this case, was probably masked during the AFB smear testing due to a treatment regimen of fluoroquinolone. The general radiological definition of tuberculosis primarily consists of older studies, with the expected presentation being a combination of cavitation and infiltration. Normal lung imaging results had also been described for tuberculosis regarding chest radiography, and studies have reported the presence of atelectasis in patients with tuberculosis, as seen in tomography case series; however, the isolation of atelectasis had not been specified in the studies. Conclusion Pulmonary tuberculosis may present itself with a myriad of radiological findings. This presentation often complicates the diagnostic process; however, differential diagnosis can be achieved via a combination of clinical symptoms and rapid culture sampling.

Interstitial Pneumonia with Autoimmune Features (IPAF) is a newly defined connective tissue disease (CTD) related pulmonary involvement in 2015 by the European Respiratory Society and American Thoracic Society. It is used to define the subgroup of patients with no known CTD history. In this case report, we present a patient with IPAF diagnosis, who had rapid clinical deterioration after a COVID-19 infection, which was attributed to a newly diagnosed pulmonary hypertension. A 69-year-old male patient with chronic obstructive pulmonary disease (COPD) diagnosis was on the routine follow-up for a duration of five years. He had been diagnosed with type 2 diabetes mellitus and gout, with under constant follow-up for a known cardiovascular arterial disease history. During a routine pulmonary evaluation, the patient had stated a worsening exercise capacity and an increase in coughing. The requested high-resolution computed tomography showed emphysema at the upper lobes and a reticular pattern at the lower lobes, with honeycombing, traction bronchiectasis, and ground-glass findings. After a rheumatology consultation, which excluded the presence of an underlying rheumatological disease, the patient was diagnosed with IPAF. Under immunosuppressive treatment, the patient complained of increased dyspnea at a routine follow-up after a COVID infection in 2021, and antifibrotic treatment was initiated due to the progression of pulmonary fibrosis. During routine follow-up, further limitation in exercise capacity was evident, for which extra-pulmonary involvement was investigated. Pulmonary hypertension (PH) diagnosis was confirmed with vasoreactivity positivity; however, due to both progression in IPAF and concurrent PH, the patient was lost during the follow-up. As seen in this case, despite being stable for years, the addition of another comorbidity may rapidly worsen a patient’s otherwise stable clinical condition. While antifibrotic regimens may be used on a case-by-case basis, their effect on disease progression may not be sufficient to control an already present comorbidity, such as pulmonary hypertension.