Pulmonary sequelae in a patient recovered from swine flu

Abstract

The pandemic of swine flu (H1N1) influenza spread to involve the whole world rapidly. Many patients manifested a mild clinical illness but some developed pneumonia and respiratory failure. High mortality was observed in patients with severe disease. Among survivors, studies are limited. Ground-glass opacities on a high-resolution computerized tomography scan and reduced diffusion capacity were noted after 3 months in a study. But long-term complications in patients with swine flu pneumonia have not been studied well. We are presenting an unusual case of swine flu pneumonia who developed interstitial lung disease after recovery.

Keywords: Complications; Influenza A virus H1N1 subtype; diffuse parenchymal lung disease; pulmonary fibrosis.

Figure 1

High-resolution CT scan at the time of discharge showing ground-glass haziness with areas of consolidation in (a) upper lobes and (b) bilateral lower lobes suggestive of alveolar inflammation.

Figure 2

(a) Chest X-ray on follow-up showing reticulonodular shadows predominantly involving a bilateral lower zone with an apical-basal gradient. (b) High-resolution CT scan on follow-up showing ground-glass haziness with reticulonodular shadows involving bilateral lungs, traction bronchiectasis, and peripheral honeycombing.

Figure 3

HRCT on follow up after 2 years in supine (a) and prone (b) position showing ground glass opacities, interstitial fibrosis and traction bronchectasis in bilateral lung fields. The opacities do not change in prone position.

Figure 4

(a) Transbronchial lung biopsy (hematoxylin and eosin stain) showing fibroblasts adjacent to the bronchial cartilage (arrow). (b) Transbronchial lung biopsy (Van Gieson's stain) showing multiple areas of collagenous tissue (stained in pink color) and fibroblasts (elongated cells with brown-colored nuclei).