A Fatal Case of Coronavirus Disease 2019 (COVID-19) in a Patient With Idiopathic Pulmonary Fibrosis

Rajasurya, Venkat; Gunasekaran, Kulothungan; Damarla, Vijay; Kolluru, Anuradha

doi:10.7759/cureus.8432

Cited by 12 publications

(10 citation statements)

References 5 publications

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“…This group of patients is at a higher risk of infections given their immunosuppressed status due to concurrent or sequential chemotherapy and immunotherapy. Other differences include organizing pneumonia, drug-induced pneumonitis (immune checkpoint inhibitor pneumonitis), e-cigarette or vaping-use associated lung injury (EVALI), thromboembolic disease (SARS-CoV-2 infection also increases the risk of venous thromboembolism), interstitial lung disease, heart failure, lymphangitic carcinomatosis, and progression of malignancy [ 66 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ].…”

Section: Diagnosis Of Radiation Pneumonitismentioning

confidence: 99%

Radiation-Induced Lung Injury—Current Perspectives and Management

Rahi

Parekh

Pednekar

et al. 2021

Clinics and Practice

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Radiotherapy plays an important role in the treatment of localized primary malignancies involving the chest wall or intrathoracic malignancies. Secondary effects of radiotherapy on the lung result in radiation-induced lung disease. The phases of lung injury from radiation range from acute pneumonitis to chronic pulmonary fibrosis. Radiation pneumonitis is a clinical diagnosis based on the history of radiation, imaging findings, and the presence of classic symptoms after exclusion of infection, pulmonary embolism, heart failure, drug-induced pneumonitis, and progression of the primary tumor. Computed tomography (CT) is the preferred imaging modality as it provides a better picture of parenchymal changes. Lung biopsy is rarely required for the diagnosis. Treatment is necessary only for symptomatic patients. Mild symptoms can be treated with inhaled steroids while subacute to moderate symptoms with impaired lung function require oral corticosteroids. Patients who do not tolerate or are refractory to steroids can be considered for treatment with immunosuppressive agents such as azathioprine and cyclosporine. Improvements in radiation technique, as well as early diagnosis and appropriate treatment with high-dose steroids, will lead to lower rates of pneumonitis and an overall good prognosis.

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Section: Diagnosis Of Radiation Pneumonitismentioning

confidence: 99%

Radiation-Induced Lung Injury—Current Perspectives and Management

Rahi

Parekh

Pednekar

et al. 2021

Clinics and Practice

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“…IPF was associated with poor short and long term prognosis [12]. Although sepsis has been cited as a complication in those with IPF, to my knowledge there is only a single case report so far detailing COVID-19 sepsis in a patient with a history of IPF [13]. The outcome of the patient was fatal in that case too.…”

Section: Discussionmentioning

confidence: 99%

Overwhelming COVID-19 Sepsis in a Patient With Idiopathic Pulmonary Fibrosis

Akram¹

2020

Cureus

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The new disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was dubbed coronavirus disease 2019 (COVID-19) by the World Health Organization and declared a pandemic. Initially thought to be a pathogen that primarily attacks the lungs, SARS-CoV-2 has turned out to be a much more formidable foe impacting almost every organ and system aggressively. I report the case of a 60-year-old man who came to the ED due to symptoms of high fever, headache, mild confusion, dry cough and exacerbated dyspnea since the last 24 hours. He had a history of idiopathic pulmonary fibrosis (IPF) and was undergoing treatment with antifibrotic medication. Apart from IPF, he had no other comorbid. He acquired SARS-CoV-2 infection by close contact and infection deteriorated into pneumonia and septic shock. Complete blood count showed white blood cells at 3.3×10 3 /μL and platelets at 71×10 3 /μL; lymphocyte count was low. Arterial blood gases revealed metabolic acidosis. Definitive diagnosis was by a positive real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens, and high-resolution computed tomography (HRCT) finding of new-onset ground-glass opacities on the very first day of admission that was the presenting day. The patient became unresponsive and died overnight. As numbers of COVID-19 show an uprise, this case highlights that IPF patients with relatively advanced age need to exercise extra caution because they are at high risk for developing overwhelming COVID-19-linked sepsis, which may be fatal.

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“…pandemic, suggest there could be substantial brotic consequences following SARS-CoV-2 infection [5,[19][20][21][22]. Given the huge numbers of individuals infected by SARS-CoV-2, it is important to identify and predict the occurrence of pulmonary brosis in the survivor population after discharge.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary fibrosis and its related factors in discharged patients with new coronavirus pneumonia: A cohort study of 90-150 days follow-up after onset

Shen

Wang

et al. 2020

Preprint

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Background: Thousands of the Coronavirus Disease 2019 (COVID-19) patients have been discharged from hospitals, long-term follow-up studies are required to evaluate the prevalence of post-COVID-19 fibrosis.Methods: This study involves 462 laboratory confirmed patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital from January 11, 2020 to April 26, 2020. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 289 patients were followed up from 90 days to 150 days after the onset of the disease.Results: Parenchymal bands, irregular interfaces, meshwork and traction bronchiectasis were the most common CT features in all COVID-19 patients. 86.87%, 74.40%, 79.56%, 68.12% and 62.03% patients developed with pulmonary fibrosis and 4.53%, 19.61%, 18.02%, 38.30% and 48.98% patients reversed pulmonary fibrosis during the 0-30, 31-60, 61-90, 91-120 and >120 days after onset, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. A predictive model of the persistence with pulmonary fibrosis was developed based-on the Logistic Regression method with an accuracy, PPV, NPV, Sensitivity and Specificity of the model of 76%, 71%, 79%, 67%, and 82%, respectively. Only a fraction of COVID-19 patients suffered with abnormal lung function after 90 days from onset, and the ratio of abnormal lung function did not differ on a statistically significant level between the fibrotic and non-fibrotic groups.Conclusions: Long-term pulmonary fibrosis was more likely to develop in patients with older age, high BMI, severe/critical condition, fever, long time to turn the viral RNA negative, pre-existing disease and delay to admission. Fibrosis developed in COVID-19 patients could be reversed in about a half of the patients after 120 days from onset. The pulmonary function of most of COVID-19 patients with pulmonary fibrosis could turn to normal condition after three months from onset. An effective prediction model with an average Area Under the Curve (AUC) of 0.84 was established to predict the persistence of pulmonary fibrosis in COVID-19 patients for early diagnosis.

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A Fatal Case of Coronavirus Disease 2019 (COVID-19) in a Patient With Idiopathic Pulmonary Fibrosis

Cited by 12 publications

References 5 publications

Radiation-Induced Lung Injury—Current Perspectives and Management

Radiation-Induced Lung Injury—Current Perspectives and Management

Overwhelming COVID-19 Sepsis in a Patient With Idiopathic Pulmonary Fibrosis

Pulmonary fibrosis and its related factors in discharged patients with new coronavirus pneumonia: A cohort study of 90-150 days follow-up after onset

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