Overwhelming COVID-19 Sepsis in a Patient With Idiopathic Pulmonary Fibrosis

Abstract

The new disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was dubbed coronavirus disease 2019 (COVID-19) by the World Health Organization and declared a pandemic. Initially thought to be a pathogen that primarily attacks the lungs, SARS-CoV-2 has turned out to be a much more formidable foe impacting almost every organ and system aggressively. I report the case of a 60-year-old man who came to the ED due to symptoms of high fever, headache, mild confusion, dry cough and exacerbated dyspnea since the last 24 hours. He had a history of idiopathic pulmonary fibrosis (IPF) and was undergoing treatment with antifibrotic medication. Apart from IPF, he had no other comorbid. He acquired SARS-CoV-2 infection by close contact and infection deteriorated into pneumonia and septic shock. Complete blood count showed white blood cells at 3.3×10³/μL and platelets at 71×10³/μL; lymphocyte count was low. Arterial blood gases revealed metabolic acidosis. Definitive diagnosis was by a positive real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens, and high-resolution computed tomography (HRCT) finding of new-onset ground-glass opacities on the very first day of admission that was the presenting day. The patient became unresponsive and died overnight. As numbers of COVID-19 show an uprise, this case highlights that IPF patients with relatively advanced age need to exercise extra caution because they are at high risk for developing overwhelming COVID-19-linked sepsis, which may be fatal.

Keywords: covid-19; idiopathic pulmonary fibrosis; severe sepsis.

Figure 1. High-resolution computed tomographic features of usual interstitial pneumonia

Diffuse interlobar interstitial thickening is noted at bilateral aerated lungs (red arrows) along with honeycombing more prevalent at lung bases (short black arrows) and mild traction bronchiectasis at left upper lobe (longer black arrows at the top)

Figure 2. High-resolution computed tomography scan of a COVID-19 patient with preexisting idiopathic pulmonary fibrosis

New-onset bilateral ground-glass haze (black arrows) superimposed on underlying usual interstitial pneumonia