AGGRESSIVE AND RAPID NASCENT HONEY COMBING DURING ACUTE COVID-19 INFECTION: A CASE REPORT

Abstract

TYPE: Case Report TOPIC: Diffuse Lung Disease INTRODUCTION: Concurrent ILD and COVID-19 portends worse mortality and complications than COVID-19 without ILD. Current studies mainly concern patients with known ILD, but had not explored if COVID-19 may unmask previously subclinical ILD or initiate a primary ILD response. CASE PRESENTATION: A fit 60yr old male, ex-smoker presented twice within a month with progressive breathlessness, fever and fatigue. He had no previous history of interstitial lung disease and had normal chest radiograph 6 months ago. He was Covid Positive in the community. On examination he was hypoxic on room air with pO2 6.65 Kpa. Chest xray showed Covid pneumonitis, moderate disease. He received remdesivir, oxygen and was pulsed with methyl prednisolone. A CT scan demonstrated extensive new honey combing in UIP pattern disease. Autoimmune profile was unremarkable. He was discharged without needing ventilatory support. Subsequent 2 month interval CT demonstrated rapid progression (increase disease volume >40%). DISCUSSION: Initial imaging with the chest radiograph for COVID may miss patients with either nascent ILD or subclinical ILD triggered by COVID pneumonitis; when it "spots the consolidation but miss the fibrosis". Rapid fibrosis in these aggressive presentations necessitate shorter duration interval imaging and clinical follow up. It is unclear if the fibrosis eventually burns out, necessitating longer term follow up. CONCLUSIONS: Whilst current post-COVID-19 ILD literature focuses on fibrosis as chronic ARDS manifestation, this case demonstrates acute, aggressive nascent course of disease. It is challenging to identify and treat this cohort in a health system overwhelmed with high disease burden when initial presentation may mimic typical COVID presentation. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19