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Feng M, Zhang J, Li X, Wang S, Li Y, Dong C. Case report: Suspected organizing pneumonia secondary to severe respiratory syncytial virus pneumonia in an elderly patient. Front Med (Lausanne) 2024; 11:1394542. [PMID: 39040894 PMCID: PMC11260806 DOI: 10.3389/fmed.2024.1394542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
Respiratory syncytial virus (RSV) usually causes acute respiratory tract infection in infants. In recent years, it has gradually become an important pathogen of lower respiratory tract infection in elderly people with an underlying disease. However, at present, the treatment of severe RSV pneumonia in adults is unclear, and organizing pneumonia (OP) after severe RSV infection has rarely been reported. We reported a 76-year-old man with multiple chronic heart and lung diseases who presented with fever, cough and progressive dyspnea. Finally, severe RSV pneumonia was diagnosed after his nasopharyngeal swabs and bronchoalveolar lavage metagenomic next-generation sequencing tests were positive for RSV. After combined treatment with oral ribavirin, intravenous immunoglobulin and corticosteroids, the patient's condition largely resolved, and he was discharged. However, when the corticosteroids were gradually tapered, the disease relapsed twice, and the patient experienced fever and aggravated dyspnea. Despite the lack of pathological evidence, we highly suspected organizing pneumonia secondary to severe RSV pneumonia based on the typical imaging manifestations and the clinical characteristics of a good response to corticosteroids. Finally, this patient was successfully treated with a course of corticosteroids and followed up for 14 months in total.
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Affiliation(s)
- Min Feng
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangrui Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuai Wang
- School of Health Care Technology, Dalian Neusoft University of Information, Dalian, China
| | - Yanxia Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chang Dong
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Ntiamoah P, Biehl M, Ruesch V, Mehta AC, Farha S. Corticosteroid treatment for persistent pulmonary infiltrates following COVID-19 infection: Clearing the fog? Ann Thorac Med 2024; 19:74-80. [PMID: 38444989 PMCID: PMC10911237 DOI: 10.4103/atm.atm_121_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Systemic corticosteroids have been shown to improve outcomes in severe coronavirus disease 2019 (COVID-19) pneumonia; however, their role in post-COVID-19 persistent lung abnormalities is not well defined. Here, we describe our experience with corticosteroids in patients with persistent lung infiltrates following COVID-19 infection. RESEARCH QUESTION What is the efficacy of systemic corticosteroids in improving lung function and radiological abnormalities in patients following COVID-19 pneumonia? STUDY DESIGN AND METHODS This is a single-center retrospective study evaluating patients with persistent respiratory symptoms and abnormal chest computed tomography findings. Patients were divided into two groups based on treatment with corticosteroids: "steroid group" and "nonsteroid group." Clinical data were collected from the electronic medical records. RESULTS Between March 2020 and December 2021, 227 patients were seen in the post-COVID-19 pulmonary clinic, of which 75 were included in this study. The mean age was 56 years, 63% were female, and 75% were white. The main physiologic deficit was reduced Diffusing capacity of the Lungs for Carbon Monoxide (DLCO) at 72% (±22). On chest imaging, the most common findings were ground-glass opacities (91%) and consolidation (29%). Thirty patients received corticosteroid (steroid group) and 45 did not (nonsteroid group). Patients treated with corticosteroids had lower DLCO (DLCO [%]: steroid group 63 ± 17, nonsteroid group 78 ± 23; P = 0.005) and all had ground-glass opacities on imaging compared to 84% in the nonsteroid group (P = 0.04). At follow-up, patients in the steroid group (n = 16) had a significant improvement in spirometry and DLCO. In addition, there was a significant improvement with resolution of ground-glass opacities in both the groups (P < 0.05). CONCLUSION The use of systemic corticosteroids in patients with persistent respiratory symptoms and radiological abnormalities post-COVID-19 was associated with significant improvement in pulmonary function testing and imaging. Prospective studies are needed to confirm whether these findings are the effect of corticosteroid therapy or disease evolution over time.
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Affiliation(s)
- Prince Ntiamoah
- Department of Pulmonary and Critical Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michelle Biehl
- Department of Pulmonary and Critical Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Victoria Ruesch
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Atul C. Mehta
- Department of Pulmonary and Critical Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samar Farha
- Department of Pulmonary and Critical Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Siafarikas C, Stafylidis C, Tentolouris A, Samara S, Eliadi I, Makrodimitri S, Spandidos D, Mathioudakis N, Karamichalos P, Papalexis P, Chlapoutakis S, Sklapani P, Trakas N, Georgakopoulou V. Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature. Exp Ther Med 2022; 24:453. [PMID: 35720626 PMCID: PMC9199065 DOI: 10.3892/etm.2022.11379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Organizing pneumonia (OP) is a type of diffuse interstitial lung disease, which may be
induced in the context of several clinical conditions, such as drug reactions, infections,
autoimmune diseases and cancer. Coronavirus disease 2019 (COVID-19)-associated OP has been
reported as a late-stage consequence of the infection or a histological form of
COVID-19-associated pneumonia. Autopsies and postmortem lung biopsies have demonstrated
that the majority of patients with COVID-19-associated pneumonia develop secondary OP, and
COVID-19-associated pneumonia and OP have common radiological features. The diagnosis of
COVID-19-associated OP should be suspected in patients with severe acute respiratory
syndrome coronavirus 2 infection who exhibit clinical deterioration despite optimal care,
or who have aggravating symptoms following an initial recovery. The use of corticosteroids
is a typical treatment for OP. However, to date, at least to the best of our knowledge,
there are a few reports regarding the role of corticosteroids in COVID-19-associated
pneumonia; thus, the optimal time for administration, the dose and treatment duration have
not yet been determined. The present study presents two cases of patients with COVID-19,
who exhibited clinical deterioration following the initial phase of infection and with
radiological characteristics of OP who received corticosteroids and had a favorable
outcome. The early diagnosis of COVID-19-associated OP may lead to targeted treatment,
decreased requirements for ventilatory support and an improved survival rate.
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Affiliation(s)
- Christos Siafarikas
- First Department of Propedeutic and Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Stafylidis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propedeutic and Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stamatia Samara
- Department of Infectious Diseases‑COVID‑19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Irene Eliadi
- Department of Infectious Diseases‑COVID‑19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Sotiria Makrodimitri
- Department of Infectious Diseases‑COVID‑19 Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Demetrios Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | | | | | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Vasiliki Georgakopoulou
- Department of Infectious Diseases‑COVID‑19 Unit, Laiko General Hospital, 11527 Athens, Greece
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Nakakubo S, Kamada K, Yamashita Y, Nakamura J, Matsumoto M, Horii H, Sato K, Morinaga D, Suzuki M, Okazaki N, Takakuwa E, Matsuno Y, Konno S. Delayed-onset Organizing Pneumonia Emerging after Recovery from Coronavirus Disease 2019: A Report of Three Cases Diagnosed Using Transbronchial Cryobiopsy and a Review of the Literature. Intern Med 2022; 61:1403-1410. [PMID: 35249922 PMCID: PMC9152860 DOI: 10.2169/internalmedicine.9016-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We present three cases with an atypical clinical course of organizing pneumonia (OP) secondary to coronavirus disease 2019 (COVID-19). Three patients were discharged with satisfactory improvement after standard steroid therapy for COVID-19. Shortly after the completion of treatment, the patients experienced a flare-up of symptoms. Imaging results showed new lesions in the lungs. Transbronchial lung cryobiopsy showed histological findings consistent with OP in all cases. Steroids were administered, and a good therapeutic response was observed. This report is the first to describe pathologically confirmed OP that developed after recovery from COVID-19. Careful follow-up is advisable for patients who have recovered from COVID-19.
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Affiliation(s)
- Sho Nakakubo
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Keisuke Kamada
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Yu Yamashita
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Munehiro Matsumoto
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Hiroshi Horii
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Kazuki Sato
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Daisuke Morinaga
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Nanase Okazaki
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Extracorporeal Membrane Oxygenation for Secondary Organizing Pneumonia after Severe SARS-CoV-2 Infection: A Case Report. MEDICINA-LITHUANIA 2021; 57:medicina57101013. [PMID: 34684050 PMCID: PMC8541682 DOI: 10.3390/medicina57101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
(Background) COVID-19 is caused by SARS-CoV-2 infection and may result in unfavorable outcomes. A recent large-scale study showed that treatment with dexamethasone leads to favorable outcomes in patients with severe COVID-19, and the use of extracorporeal membrane oxygenation (ECMO) has also been shown to improve outcomes. Recently, secondary organizing pneumonia (SOP) has been reported after SARS-CoV-2 infection, but the diagnostic and treatment strategies are still unclear. (Case presentation) Here, we report a patient with severe COVID-19 who developed SOP even after the use of dexamethasone, for whom the introduction of ECMO on the 19th day after hospitalization led to a favorable outcome. (Conclusions) Life-threatening SOP may evolve even after the use of dexamethasone, and the late-phase introduction of ECMO may save such patients with COVID-19.
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Funke-Chambour M, Bridevaux PO, Clarenbach CF, Soccal PM, Nicod LP, von Garnier C. Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID. Respiration 2021; 100:826-841. [PMID: 34091456 PMCID: PMC8339046 DOI: 10.1159/000517255] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Emerging evidence suggests that long-term pulmonary symptoms and functional impairment occurs in a proportion of individuals following SARS-CoV-2 infection. Although the proportion of affected patients remains to be determined, physicians are increasingly being confronted with patients reporting respiratory symptoms and impairment beyond the acute phase of COVID-19. In face of limited evidence, the Swiss Society for Pulmonology established a working group to address this area of unmet need and formulated diagnostic and treatment recommendations for the care of patients with pulmonary long COVID (LC). METHOD The Swiss COVID Lung Study group and Swiss Society for Pulmonology (SSP) formulated 13 questions addressing the diagnosis and treatment of pulmonary LC. A survey within the SSP special interest groups involved in care of LC patients was conducted in Switzerland. A CORE process/Delphi-like process was used to formulate recommendations. Forty experienced pulmonologists replied to the first survey and 22 completed the second follow-up survey. Agreement of ≥70% consensus led to formulation of a recommendation. RESULTS The participants in the survey reached consensus and formulated a strong recommendation for regarding the following points. Patients hospitalized for COVID-19 should have a pulmonary assessment including pulmonary function tests. Symptomatic subjects affected by COVID-19, including those with mild disease, should benefit from a pulmonary follow-up. Persistent respiratory symptoms after COVID-19 should be investigated by a pulmonary follow-up including plethysmography, diffusion capacity measurement, and blood gases analysis. Individuals having suffered from COVID-19 and who present with persistent respiratory symptoms should be offered a rehabilitation. Additional questions were given moderateor weak recommendations for. The panel did not reach sufficient consensus for pharmacological therapy (e.g., therapy specifically targeting lung fibrosis) to formulate recommendations for LC drug treatment. CONCLUSION The formulated recommendations should serve as an interim guidance to facilitate diagnosis and treatment of patients with pulmonary LC. As new evidence emerges, these recommendations may need to be adapted.
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Affiliation(s)
- Manuela Funke-Chambour
- Department for Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Pulmonary Medicine, BioMedical Research, University of Bern, Bern, Switzerland
| | - Pierre-Olivier Bridevaux
- Service de Pneumologie, Hôpital du Valais, Sion, Switzerland
- Geneva Medical School, University of Geneva, Geneva, Switzerland
| | | | - Paola M. Soccal
- Geneva Medical School, University of Geneva, Geneva, Switzerland
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent P. Nicod
- Pulmonary Medicine, Clinique Cecil du groupe Hirslanden, Lausanne, Switzerland
- Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Christophe von Garnier
- Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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