Recurrence of bilateral polysegmental pneumonia associated with COVID-19 (clinical case)

Abstract

COVID-19 (clinical case)We describe a clinical case of long-term follow-up of a patient who had experienced bilateral polysegmental pneumonia associated with COVID-19 twice within 16 months.Patient, 52 years old, resident of the countryside. He fell ill acutely on 01/06/2020. He turned to the rural outpatient clinic with a paramedic complaining of an increase in body temperature up to 39.0 °С, shortness of breath with little physical exertion, cough with massive sputum production. He began treatment at the regional hospital, later continued at the Ternopil Regional Phthisiopulmonology Medical Center. A clinical diagnosis was made — community-acquired bilateral polysegmental pneumonia, severe course, group III. COPD, group B (GOLD 2) infectious exacerbation. P I II, intoxication syndrome. After inpatient treatment, a partial improvement was clinically determined, and radiographically, the resorption of inhomogeneous infiltration, but an increase in matte consolidation fields. It was during this period that a lockdown was introduced in the country in connection with the COVID-19 pandemic. Considering certain clinical and, in particular, radiological features of the course of the disease in a patient, COVID-19 can be suspected, at that time a PCR test was not yet performed. Until August 2020, the patient received outpatient treatment and was observed by a family doctor at the place of residence. In August 2020, the patient underwent a follow-up examination. Clinical and radiological improvement was noted. But the condition deteriorated sharply in the second half of November 2020. From 11/27/2020 to 12/14/2020, he was treated at the regional CRH for COVID-19, PCR+, severe course of community-acquired bilateral pneumonia. On the control CT scan (December 30, 2020) — in dynamics from August 13, 2020, progression — an increase in the area of ​​the lesion. Treatment continued at the Ternopil Regional Phthisiopulmonological Medical Center, and after discharge on an outpatient basis. At the control examination (06/16/2021), in the dynamics from 12/30/2020, the resorption of fibrous seals, a decrease in the intensity of consolidation areas. Conclusion: CT picture of chronic fibrosing lung disease, resorption phase.The patient was diagnosed with bacterial-viral pneumonia, which clinically and radiologically resembled pneumonia associated with COVID-19. Clinical and radiographic findings showed improvement after 7 months of treatment. After 10 months from the date of the first detection of the disease, the patient was re-diagnosed with pneumonia associated with COVID-19. Long-term inpatient and outpatient treatment was carried out, as a result of which it was possible to achieve clinical and radiological stabilization of the process and resorption of changes in the lungs.