Successful Treatment with High-dose Steroids for Acute Exacerbation of Idiopathic Pulmonary Fibrosis Triggered by COVID-19

Abstract

We herein report a case of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) triggered by COVID-19. An 87-year-old woman tested positive for COVID-19 on a polymerase chain reaction test, and computed tomography revealed ground-glass opacity (GGO) superimposed on a background pattern consistent with usual interstitial pneumonia. Considering these data, we diagnosed her with AE-IPF. She experienced worsening of dyspnea and expansion of the GGO. Therefore, we introduced high-dose steroids (methylprednisolone 250 mg/day for 3 days). After the treatment, the pulmonary infiltrates improved. She was discharged from our hospital without severe disability. High-dose steroids can be a viable treatment option for AE-IPF triggered by COVID-19.

Acute exacerbation of rheumatoid arthritis-associated interstitial lung disease triggered by COVID-19: What is the best practice for treatment?

“…Given that a recent study reported the presence of ILD as a poor prognostic contributor in COVID-19 patients with RA [ 1 ], there might be potentially a certain number of patients with AE-ILD. As these reports of AE- ILD triggered by COVID-19 are still limited, further investigations are required [ [8] , [9] , [10] ].…”

“…Second, we added high-dose corticosteroids to dexamethasone. Although the clear evidence is lacking, most international experts use high-dose corticosteroids for treating AE-ILD [ 16 ], and we have experienced the beneficial effects for AE-IPF triggered by COVID-19 [ 8 , 9 ]. Meanwhile, a recent double-blind RCT failed to demonstrate the efficacy of high-dose corticosteroids in patients with COVID-19 [ 17 ].…”

COVID-19-Triggered Acute Exacerbation of IPF, an Underdiagnosed Clinical Entity With Two-Peaked Respiratory Failure: A Case Report and Literature Review

“…Typical severe COVID-19 exhibits sudden respiratory failure with newly developed bilateral lung opacities on chest CT, which are also common in AE-ILDs. Indeed, according to recent reports demonstrating cases of acute respiratory failure in patients with pre-existing chronic ILDs ( 10 – 12 ), it is hard, if not impossible, to distinguish severe COVID-19 from AE-ILDs triggered by COVID-19. In this case, we observed extension of peripheral dominant GGOs at the time of clinical recovery from COVID-19 ( Figure 1C ).…”

“…As the pandemic of COVID-19 being prolonged, increasing number of cases with chronic ILDs who developed severe respiratory failure by complication with COVID-19 has been reported. We reviewed and summarized them in Table 2 (8,11,12,(16)(17)(18)(19). The majority of the cases developed respiratory failure with newly-emerged GGOs simultaneously with the diagnosis of COVID-19, therefore treated with combination of antiviral and immunomodulation therapy against COVID-19.…”

SARS-CoV-2-Infektion und interstitielle Lungenerkrankungen – Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin

“…Erleiden Patienten mit einer vorbestehenden ILD eine SARS-CoV-2-Infektion, so haben sie ein höheres Risiko für einen schweren oder letalen Verlauf der COVID19-Erkrankung [29][30][31]. Die frühe und verlässliche Diagnose einer SARS-CoV-2-Infektion hat damit erhebliche Bedeutung für die Behandlung und das Monitoring der erkrankten Patienten.…”