Delayed organising pneumonia in an immunocompromised host after a mild COVID-19 infection

The study titled “Delayed organising pneumonia in an immunocompromised host after a mild COVID-19 infection” presents a case that underscores the diagnostic challenges and treatment considerations for organising pneumonia following COVID-19, particularly in immunocompromised individuals.

Here’s a detailed summary:

Background

  • Organising pneumonia is an established complication of severe COVID-19, with a reported prevalence as high as 12.5%. This case study focuses on its occurrence as a late complication after a mild COVID-19 infection in an immunocompromised patient, shedding light on the disease progression, treatment response, and clinical outcome in such populations​​.

Case Presentation

  • The patient, a man in his 50s with a history of lymphoma in remission and on rituximab treatment, presented with persistent fever and a mild cough a month after recovering from a mild COVID-19 infection. Notably, he did not experience severe respiratory symptoms during his COVID-19 infection and had been vaccinated with two doses of an mRNA vaccine seven months prior​​.

Investigations and Diagnosis

  • Initial blood tests showed high C-reactive protein and mildly raised procalcitonin levels, but other laboratory tests, including a septic workup and autoimmune markers, were unremarkable. Chest X-rays revealed bilateral lower zone lung consolidation. Despite being treated for community-acquired pneumonia, his symptoms persisted, and a CT scan showed widespread ground-glass appearances in the lungs. A bronchoscopy with transbronchial lung biopsy confirmed the diagnosis of organising pneumonia​​.

Treatment and Outcome

  • The patient was treated with a tapering regimen of prednisolone, starting with 30 mg per day. His fever resolved within 48 hours, and his respiratory symptoms improved significantly. Follow-up after 6 weeks showed continued symptom resolution, although some radiological signs still persisted. His treatment was adjusted accordingly, and complete radiological improvement was noted 8 weeks later​​.

Discussion

  • This case contributes to the limited but emerging evidence suggesting that organising pneumonia can occur following COVID-19 infection. While corticosteroids are generally considered the standard treatment for organising pneumonia, the case highlights that treatment should be tailored on a case-by-case basis, especially in immunocompromised patients. The case also brings attention to the potential risk of delayed organising pneumonia following a mild COVID-19 infection in immunocompromised individuals, possibly due to prolonged viral shedding and poor antibody development against COVID-19​​.

In summary, this case report emphasizes the importance of considering organising pneumonia as a differential diagnosis in persistent fever and lung abnormalities post-COVID-19, especially in immunocompromised patients. It also highlights the effectiveness of glucocorticoid therapy in such cases, contributing to a deeper understanding of the post-COVID-19 complications and their management.

Read More: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10193096/pdf/bcr-2023-254737.pdf

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