Organizing pneumonia and COVID-19: A report of two cases

Simões, Joana; Ferreira, Ana Rita; Almeida, Pedro Martins; Trigueiros, Frederico; Braz, Armando; Inácio, J.; Medeiros, Fábio Cota; Bráz, Sandra; Lacerda, António Pais de

doi:10.1016/j.rmcr.2021.101359

Cited by 12 publications

(11 citation statements)

References 16 publications

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“…Though reports of temporal changes vary, it seems a third will resolve in one to two months after acute infection ( 76 ). Corticosteroids have been reported to speed resolution of these abnormalities ( 81 , 82 ) and it is speculated that the impact of steroids on outcome measures in acute COVID-19 ( 83 , 84 ) may be in part due to treatment of OP or AFOP. However, in the absence of clinical trials, we would caution against the use of steroid treatment based on imaging findings alone.…”

Section: Post-acute Sequelae Of Covid-19mentioning

confidence: 99%

CT of Post-Acute Lung Complications of COVID-19

et al. 2021

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The acute course of coronavirus disease 2019 (COVID-19) is variable and ranges from asymptomatic infection to fulminant respiratory failure. Patients recovering from COVID-19 can have persistent symptoms and computed tomography (CT) abnormalities of variable severity. At 3 months after acute infection, a subset of patients will have CT abnormalities that include ground glass abnormalities (GGO) and subpleural bands with concomitant pulmonary function abnormalities. At 6 months after acute infection, some patients have persistent CT changes to include the resolution of GGOs seen in the early recovery phase and the persistence or development of changes suggestive of fibrosis such as reticulation with or without parenchymal distortion. Predictors of post-COVID lung disease include need for intensive care unit (ICU) admission, mechanical ventilation, higher inflammatory markers, longer hospital stay and a diagnosis of acute respiratory distress syndrome (ARDS). Treatments of post-COVID lung disease are being investigated with anti-fibrotic agents being investigated for the prevention of post-COVID lung fibrosis. The etiology of post-COVID lung disease may be a sequela of prolonged mechanical ventilation, COVID-induced ARDS or direct injury from the virus. Future research is needed to determine the long-term persistence of post-COVID lung disease, its impact on patients and ways to prevent or treat it.

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Section: Post-acute Sequelae Of Covid-19mentioning

confidence: 99%

CT of Post-Acute Lung Complications of COVID-19

et al. 2021

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“…It is possible that patients with this pro-thrombotic state progress earlier from a (pre-)exudative stage of diffuse alveolar damage to an organizing and fibrotic phase [21]. This has been confirmed in several case report series in which patients were diagnosed, either radiographically or with transbronchial biopsy, with organizing pneumonia during their primary COVID-19 infection [22,23]. This finding is also supported by other autopsy studies reporting a spectrum of parenchymal histopathology patterns: from organizing pneumonia or acute fibrinous and organizing pneumonia to a pattern of diffuse alveolar damage, mostly in organizing stage [5,7].…”

Section: Discussionmentioning

confidence: 84%

Organizing Pneumonia and Microvascular Fibrosis as Late Sequelae after a COVID-19 Infection. A Case Report

et al. 2021

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We report a patient with COVID-19 requiring hospitalization for two weeks, complicated by multiple segmental pulmonary embolisms for which dabigatran was initiated. After clearing the infection, the patient remained asymptomatic for 5 months. He was then readmitted with a spontaneous haemothorax, most likely related to the use of dabigatran, which progressed to a pleural empyema with a trapped lung. The patient underwent a video assisted thoracoscopy (VATS) with decortication. Because of focal abnormalities, biopsies for histopathology were taken from the lung parenchyma. These showed an organizing pneumonia with progression towards fibrosis and arteries with intimal fibrosis. So far, no histopathological reports exist on late pulmonary changes after a COVID-19 infection. The unusual combined presence of microvascular damage and interstitial fibrosis may reflect a pathophysiological concept in which early endothelial damage by SARS-CoV-2 can lead to a chronic state of microvascular damage, low grade inflammation, and early progression towards pulmonary fibrosis.

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“…COVID-19 pneumonia after a prolonged course of corticosteroids, some of them with organizing pneumonia corroborated by transbronchial biopsies (2)(3)(4). Autopsy reports have reported findings of acute fibrinoid organizing pneumonia supporting the benefit of corticosteroid therapy (5).…”

Section: Previous Series Have Described Clinical Improvement Of Patients With Non-resolvingmentioning

confidence: 89%