Secondary organizing pneumonia after recovery of mild COVID‐19 infection

Abstract

A 36‐year‐old male with diffuse large B‐cell lymphoma on maintenance rituximab therapy presented to the emergency department with high fever and fatigue. A chest X‐ray showed a lobar infiltrate, 40 days before admission the patient suffered from a mild coronavirus disease 2019 (COVID‐19) infection and fully recovered. PCR nasopharyngeal swab was negative for COVID‐19. Comprehensive biochemical, radiological, and pathological evaluation including 18‐fluorodeoxyglucose positron emission tomography with computed tomography and transbronchial lung biopsy found no pathogen or lymphoma recurrence. Treatment for pneumonia with antibiotic and antifungal agents was nonbeneficial. A diagnosis of secondary organizing pneumonia (OP) was made after pneumonia migration and a rapid response to corticosteroids. OP secondary to a viral respiratory infection has been well described. Raising awareness for post‐COVID‐19 OP has therapeutic and prognostic importance because those patients benefit from steroid therapy. We believe the condition described here is underdiagnosed and undertreated by doctors worldwide. Because of the ongoing global pandemic we are now encountering a new kind of patient, patients that have recovered from COVID‐19. We hope that this case may contribute to gaining more knowledge about this growing patient population.

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

“…Prednisone at a dosage of 0.75-1.5 mg/kg/day for 4 weeks, tapered over a period of 3-6 months, is the current recommendation (33). In COVID-19-associated OP, case reports and case series, including ours, have documented favorable outcomes with corticosteroid treatment, sometimes with high doses and prolonged therapy, often weeks to months (13)(14)(15)(16)(17)(18)(19)(22)(23)(24)(25). A single-center prospective observational study discovered that almost a quarter of post-COVID-19 pneumonia patients had recurrent dyspnea with radiological signs of OP, and that restarting corticosteroids resulted in clinical and radiological improvement in these patients (27).…”

“…Clinical and investigation data regarding COVID-19associated OP are limited. The diagnosis of OP was made in some cases, by using only radiological data (13)(14)(15)(16)(17)(18)(19), and in other cases, by performing transbronchial biopsy and a histological examination of the obtained tissue (14,(20)(21)(22)(23)(24)(25). The cases of COVID-19-associated organizing pneumonia reported in the literature are summarized in Table I.…”

Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course

“…Organizing pneumonia secondary to a viral respiratory infection has been well-described ( 33 ), also in COVID-19 cases ( 30 – 32 ). These cases are probably more common than expected ( 34 ).…”

Organizing pneumonia: an unusual sequela of COVID-19 infection

“…Cryptogenic OP is idiopathic in nature and considered a diagnosis of exclusion after all other known causes of OP have been ruled out [ 4 ] . Secondary OP is associated with autoimmune diseases, including rheumatoid arthritis, haematological malignancies, certain medications, and most notably, infection [ 5 ] . Known viral triggers of secondary OP include influenza virus, parainfluenza virus, cytomegalovirus, adenovirus and human immunodeficiency virus [ 5 , 6 ] .…”

“…Secondary OP is associated with autoimmune diseases, including rheumatoid arthritis, haematological malignancies, certain medications, and most notably, infection [ 5 ] . Known viral triggers of secondary OP include influenza virus, parainfluenza virus, cytomegalovirus, adenovirus and human immunodeficiency virus [ 5 , 6 ] . To date, there have been limited reports of patients developing secondary OP following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel zoonotic virus that causes coronavirus disease 2019 (COVID-19).…”