Images in clinical medicine | Volume 37, Article 323, 07 Dec 2020 | 10.11604/pamj.2020.37.323.26263

Pulmonary fibrosis secondary to COVID-19

Muhammad Saadiq Moolla, Ilhaam Fredericks

Corresponding author: Muhammad Saadiq Moolla, Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

Received: 26 Sep 2020 - Accepted: 19 Oct 2020 - Published: 07 Dec 2020

Domain: Radiology,Infectious disease,Pulmonology

Keywords: SARS-CoV-2, COVID-19, pulmonary fibrosis, long-term complications

©Muhammad Saadiq Moolla et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Muhammad Saadiq Moolla et al. Pulmonary fibrosis secondary to COVID-19. Pan African Medical Journal. 2020;37:323. [doi: 10.11604/pamj.2020.37.323.26263]

Available online at: https://www.panafrican-med-journal.com/content/article/37/323/full

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Images in clinical medicine

Pulmonary fibrosis secondary to COVID-19

Pulmonary fibrosis secondary to COVID-19

Muhammad Saadiq Moolla1,&, Ilhaam Fredericks1

 

1Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

 

 

&Corresponding author
Muhammad Saadiq Moolla, Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

 

 

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While death is the most feared outcome of COVID-19, other serious complications are increasingly being described. A 74-years-old man with hypertension, diabetes mellitus and a Modified Medical Research Council (mMRC) dyspnoea score of 1 was admitted to our institution with a 1-week history of dyspnoea, cough and severe hypoxia. Initial chest radiograph (A) showed bilateral, peripheral, lower lobe-predominant ground glass opacities. A diagnosis of COVID-19 was confirmed with positive SARS-CoV-2 RT-PCR on nasal swab. He received oral steroids and therapeutic doses of heparin. He initially required 60% facemask oxygen, which was weaned to nasal prong oxygen over two weeks. Seven weeks after admission and despite normalisation of all inflammatory markers, he remained dyspnoeic at rest and oxygen-dependent.Follow up chest radiograph (B) demonstrated worsening diffuse reticulonodular shadowing. Chest high-resolution computed tomography (C, D) demonstrated confluent pulmonary fibrosis with an apicobasal gradient bilaterally, diffuse peripheral inter- and intra-lobular septal thickening and significant traction bronchiectasis without honeycombing.Total lung capacity and diffusing capacity of the lungs for carbon monoxide were not performed due to infective risk but are expected to be decreased. The patient was given a trial of steroids and will be followed up in 6 weeks. He will likely require domiciliary oxygen. Due to the mMRC of 1 and short history, it is assumed that the fibrosis was not present prior to the COVID-19 diagnosis. The early use of antifibrotics may prevent this devastating complication, but it is difficult to predict who is likely to progress to pulmonary fibrosis.

 

 

Figure 1: A) initial chest radiograph at time of diagnosis of COVID-19; B) follow up chest radiograph taken 7 weeks later; C, D) high-resolution computed tomography performed after 7 weeks demonstrating extensive pulmonary fibrosis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Images in clinical medicine

Pulmonary fibrosis secondary to COVID-19

Images in clinical medicine

Pulmonary fibrosis secondary to COVID-19

Images in clinical medicine

Pulmonary fibrosis secondary to COVID-19

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Pulmonary fibrosis secondary to COVID-19