Managing Post COVID-19 Patient with Breathlessness.

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may increase the severity of coronavirus disease 2019 (COVID-19) infections.
• This review focuses on a specific case of COPD exacerbation following COVID-19 and the diagnostic strategies employed.

Observation:

• A 69-year-old male with GOLD D COPD and ischemic heart disease presented with severe COVID-19 requiring high-flow nasal cannula.
• Initial CTPA revealed organizing pneumonia (OP) and emphysematous changes; treatment included baricitinib and methylprednisolone, followed by oral prednisolone and optimized COPD pharmacotherapy.
• The patient was re-admitted with dyspnea and fever, showing increased reticulations and crazy paving on CTPA, indicative of interstitial pneumonia with COVID-19 OP and fibrosis progression.

Findings:

• The patient's condition evolved from initial organizing pneumonia to interstitial pneumonia with fibrosis progression post-COVID-19.
• Treatment involved corticosteroids and optimized COPD management, with a cautious approach to inhaled corticosteroids due to pneumonia and low eosinophil count.
• Antibiotic therapy led to a positive response, and clinical and radiological improvements were noted at 3-month follow-up.

Implications:

• Close monitoring of patients with pre-existing lung conditions post-COVID-19 is essential to detect and manage interstitial lung disease.
• Optimizing management of underlying conditions like COPD is paramount in mitigating severe COVID-19 outcomes.
• Caution is advised with corticosteroid inhalers in patients with recent pneumonia and low eosinophil counts.