Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids

Abstract

Organizing pneumonia emerges as a late phase complication of COVID-19. Corticosteroids are standard therapy for organizing pneumonia, but the question of whether an approach with high dose corticosteroids would be beneficial for patients with organizing pneumonia secondary to COVID-19 remains to be answered. Herein we report a series of three patients, one male and two females, mean age 58.3 years old, admitted for COVID-19 with severe pulmonary disease requiring ventilatory support. The patients underwent chest computed tomography scans due to maintained hypoxemia, which showed a pattern compatible with organizing pneumonia. The patients were treated with a high dose of corticosteroids (prednisone 1 mg/kg PO), showing marked clinical improvement, and decreasing oxygen flow ratio demand. They were discharged after a mean period of 6.3 days of hospitalization. Our report suggests that patients with COVID-19 with organizing pneumonia might benefit from high dose corticosteroids as an adjuvant therapy.

Keywords: COVID-19; Corticosteroids; Organizing pneumonia.

Fig. 1

Pulmonary CT angiography to assess pulmonary embolism (PE) obtained on illness day 21. CT axial image (lung window) showed peripheral areas of consolidation in both lower lobes. Incipient architectural distortion is seen in central portions of the lungs. CT findings were suggestive of OP. PE was absent.

Fig. 2

Unenhanced CT was obtained 14 days after the onset of symptoms. Manifestations of OP with patchy areas of subpleural consolidation showing perilobular distribution (arrow), with associated reticular opacities (arrowhead).

Fig. 3

Pulmonary CT angiography on illness day 14. A pattern of OP is seen in the right middle and right lower lobes (consolidation and ground-glass opacities with perilobular distribution). Patchy areas of ground-glass opacities in the left lung. No signs of PE.