Atypical characteristics of COVID-19 infection on CT imaging with preexisting combined pulmonary fibrosis and emphysema: A case report

Abstract

Abstract Introduction: Combined pulmonary fibrosis and emphysema (CPFE) complicating Coronavirus Disease 2019 (COVID-19) is a challenging clinical scenario. Patient concerns: We report the case of a 44-year-old Chinese man with a medical history of CPFE showing atypical characteristics of COVID-19 infection on computed tomography (CT) imaging. Diagnoses: The patient was reported to have had close contact with a COVID-19 patient, with 4 real-time reverse transcriptase-polymerase chain reaction tests for COVID-19 - all positive. CT imaging showed scattered mixed ground-glass nodules and small ground-glass lesions in the lower and posterior parts of the posterior segment of the left upper lobes. Intervention: The patient received antiviral therapy (ritonavir tablets twice-daily, Xiyanping injection, and oral delivery of Keke capsules). Outcomes: On follow-up, nodules near the hilar side of the lung showed shrinkage at 7th day and nearly disappeared after 15 days. Conclusion: Clinicians should be alert to the results of lung CT examination and atypical lesions should be diagnosed in time. Precise clinical evaluation, well-directed monitoring, and intervention can effectively improve prognosis.