REVERSIBLE LUNG FIBROSIS FOLLOWING SEVERE COVID-19 INFECTIONA CASE REPORT

Abstract

After wide spread of COVID-19 pneumonia with thousands of cases complicated with acute respiratory distress syndrome (ARDS) of which high percentage fully recovered and resumed their normal life without any disability. It was known that those patients will have residual fibrosis which may affect their daily activity on the long run.There was always paramount question about the reversibility of such fibrosis especially with well-known concept about absence of any radical treatment for such etiology.We present a case of 54 years old male patient, non-smoker with irrelevant medical history apart from well controlled hypertension. He was referred to our facility with fever, productive cough, and shortness of breath. An initial polymerase chain reaction (PCR) screening for SARS-COV2 was positive. A high-resolution CT (HRCT) chest revealed Multi-focal patchy air-space ground glass density with peripheral and basal predominance more affecting the left side, suggestive of viral pneumonia. The patient was commenced on low flow oxygen therapy and symptomatic treatment. Four days later the symptoms aggravated and oxygen requirement increased to non-rebreathing oxygen mask (NRM). We treated him according to COVID protocol withtherapeutic anticoagulation, corticosteroids and oxygen therapy which was adjusted to maintain saturation 92%, but his condition deteriorated and was shifted to intensive care unit. Later patient improved andwas shifted back to the medical ward. We were able to wean him off oxygen and he was discharged home oncorticosteroidsand scheduled for a follow up visit in the pulmonology clinic. Repeated HRCT chest showed regressive course concerning both the airway space disease and the fibrotic changes. The patient returned to his normal life activity with no residual limitation of his physical activity or development of shortness of breath with exertion. Latest HRCT was completely normal.