Three Cases of COVID-19 Pneumonia in Female Patients in Italy Who Had Pulmonary Fibrosis on Follow-Up Lung Computed Tomography Imaging

Abstract

BACKGROUND Since December 2019, an outbreak caused by a novel coronavirus infection (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) occurred in Wuhan, China, and it rapidly spread all over the world. The clinical spectrum of coronavirus disease 2019 (COVID-19) is wide, with acute respiratory distress syndrome (ARDS) occurring in 15% of patients affected, requiring high oxygen support. Currently, there is no clearly effective antiviral therapy. Steroids and immunomodulators are under investigation for potential activity. Little is known about middle and long-term sequelae on respiratory function. According to some authors, COVID-19 could cause pulmonary fibrosis. We report 3 cases of pulmonary fibrosis detected on follow-up computed tomography (CT) imaging in 3 female patients who recovered from COVID-19 pneumonia in Italy (L'Aquila, Abruzzo). CASE REPORT All patients were female and had no significant previous respiratory disease or history of smoke exposure, and none had received high-flow oxygen support during treatment of the disease. In all cases, late onset of mild dyspnea, slow and incomplete respiratory recovery, and early evidence of fibrous signs on chest CT scan were characteristic of the clinical course. CONCLUSIONS This report focuses on a possible scenario of long-term lung damage in COVID-19 pneumonia survivors. Limitations are lack of long-term follow-up and functional data in the very early phase. It is advantageous that all COVID-19 pneumonia patients undergo serial chest CT and spirometry long-term follow-up for at least 1 year to assess residual damage. This is particularly relevant in those with slow respiratory recovery and long hospitalization.

Figure 1.

First CT scan of Patient 1 performed on March 27 after hospital admission showed multiple patchy ground-glass opacity and consolidation shadow in the bilateral lung view, which was suggestive for bilateral interstitial pneumonia.

Figure 2.

Second CT scan of Patient 1 performed on April 22 showed disease progression: increasing range of ground-glass density patches and consolidation, with scant fibrous interstitial stripes.

Figure 3.

First CT scan of Patient 2 performed on March 25 showed multiple patchy ground-glass opacity and consolidation shadow in the bilateral lung view, mainly to the left, highly suggestive for bilateral interstitial pneumonia.

Figure 4.

Second CT scan of Patient 2 performed on April 30 showed decreasing range of ground-glass density patches and consolidation but scant fibrous interstitial stripes, mainly in the basal lung segment.

Figure 5.

Timeline of symptoms, CT scan, treatment initiation, day of hospitalization, and day of discharge of all patients according to the day of illness. BID – bis in die (twice a day).

Figure 6.

Chest radiograph of Patient 3 at presentation, 2020 (illness day 11).

Figure 7.

Follow-up CT scan of Patient 3: Consolidation shadow in bilateral lung view, interlobular septal thickening, and diffuse fibrous interstitial stripes are evident. Mediastinal lymphadenopathy can also be seen.