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Case Reports
. 2020 Oct 29:16:1039-1046.
doi: 10.2147/TCRM.S275779. eCollection 2020.

A Dangerous Consequence of the Recent Pandemic: Early Lung Fibrosis Following COVID-19 Pneumonia - Case Reports

Chiara Scelfo  1 , Matteo Fontana  1 , Eleonora Casalini  1 , Francesco Menzella  1 , Roberto Piro  1 , Alessandro Zerbini  2 , Lucia Spaggiari  3 , Luca Ghidorsi  1 , Giulia Ghidoni  1 , Nicola C Facciolongo  1
Affiliations
Case Reports

A Dangerous Consequence of the Recent Pandemic: Early Lung Fibrosis Following COVID-19 Pneumonia - Case Reports

Chiara Scelfo et al. Ther Clin Risk Manag. .

Abstract

The outbreak of the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) started in China in December 2019. COVID-19 patients at presentation show a wide spectrum of clinical and pathological involvement. We report two cases of respiratory insufficiency due to COVID-19 pneumonia that occurred in adults without a history of respiratory diseases. Although these patients improved and were discharged from the acute ward, during the hospitalization they both progressed with a subsequent clinical and radiological worsening, pointing out one of the main concerns for these patients at discharge: the possibility of developing persistent lung abnormalities also in healthy people not having other risk factors. In conclusion, these cases represent two examples of early lung fibrosis in patients with COVID-19 pneumonia with different severity disease evolution and highlight the need for long-term follow-up strategies. The etiology of this fibrosis is under discussion: we suppose that it could be due to either a possible outcome of natural history of lung damage produced by ARDS, or to the lung injury related to high oxygen level or to the lung damage directly induced by viral infection or finally to the autoimmune response. At this moment, it is not possible to predict how many people will have consequences due to COVID-19 pneumonia, and therefore we believe that careful follow-up should be mandatory.

Keywords: COVID-19; computed tomography; critical care; follow-up; pulmonary fibrosis; viral disease.

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Conflict of interest statement

The authors report no conflicts of interest for this work.

Figures

Figure 1
Figure 1
(A) Case 1. Bilateral GGO with poorly defined margins and multiple patchy opacity with slight thickening of pulmonary interstitial structures. (B) Case 1. Larger extension of the opacities, with parenchymal changes including consolidations and signs of reticular interstitial thickening, linear scarring and volume loss at the upper lobes.
Figure 2
Figure 2
(A) Case 2. Multiple patchy, nodular or large opacity and GGO under the pleura, with poorly defined margins and few consolidations at the right lower lobe. (B) Case 2. Right sided pleural effusion and the presence of sub-pleural consolidations and reticular thickening involving the upper lobes.
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