ABSTRACT
SESSION TITLE: Global Pulmonary Cases SESSION TYPE: Global Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Progressive fibrosing interstitial lung diseases (PF-ILD) consist of a group of interstitial lung diseases (ILD) showing similar clinical phenotype of accelerated respiratory failure, frequent disease exacerbation with earlier mortality. CASE PRESENTATION: 48 year old male patient, smoker for 20 years (smoking index 20),presented with severe COVID pneumonia 9 months back where he has been admitted to ICU for 7 days. CTPA excluded PE but revealed severe covid pneumonia. inflammatory markers were consistent with cytokine storm. he has been commenced ono2 therapy with HNNC, steroid therapy(dexamethasone 6 mg for 15 days ), tocilizumab & remdisivir. he discharged from hospital after 15 days with o2 sat around 90 % on RA but still he has dyspnea on mild exertion. discharged on 40 mg steroid and tapered according to his repsonce.3 months later during his FU FVC was 55% of predicted with o2 sat on RA 84, 90 % on 2 L/M.HRCT chest showed diffuse reticulation with starting traction bronchiectasis more in both upper lobes occupying more than 10 % of lung parenchyma. he continued on CS 30 MG and with consideration of antifibrotic medications.after 2 months he developed pneumothorax on the right side where ICT was inserted for 7 days.4 months later he presented with gradual progressive SOB and gradual increase o2 requirement up to 6 L/M to maintain o2 sat around 90%.he became wheelchair bound during all his daily activities. FVC BECAME 40 %.ABG showed PO2 around 54 mmHg. evidence of irreversible lung disease, such as severe bullous destruction or evidence of established fibrosis.HRCT chest showed extensive reticulation with fibrotic changes, interstitial thickening associated with lung architecture distortion, with multiple bilateral bullous destruction on left and right upper lobe.(figure 1-2).MDT decide to start nintadanibe with discussion with lung transplantation team for possible listing. DISCUSSION: we reported a case of post covid lung fibrosis who is fulfilling criteria for being progressive and being fibrotic, as he showed decrease in FCV over 6 months more than 10%, progressive of respiratory symptoms and progression of lung fibrosis with development of bullous changes in both upper lobes. initially we know that it is too Early to address the POST COVID ILD in full details but there are many cases have been progressed and developed end sage fibrotic lung diseases.(1-2). then, the 2nd question that should be there, is "there any role of smoking for this rapid progression with development of this pattern".as there some reports about this risk but no clear evidence on large patient population CONCLUSIONS: is post covid lung fibrosis will be one of causes for progressive fibrosing lung pathology& what are the risk factors?the answer of these questions should be addressed as it may affect morbidity and mortality especially with increasing number of COVID cases. Reference #1: 1-Udwadia ZF, Pokhariyal PK, Tripathi AK, Kohli A. Fibrotic interstitial lung disease occurring as sequelae of COVID-19 pneumonia despite concomitant steroids. Lung India 2021;38:S61-3. Reference #2: 2-Kayhan S, Kocakoç E. Pulmonary fibrosis due to COVID-19 pneumonia. Korean J Radiol 2020;21:1273. Reference #3: 3-Vardavas CI, Nikitara K (2020) COVID-19 and smoking: a systematic review of the evidence. Tob Induc Dis. 18:20, DISCLOSURES: No relevant relationships by Usama Abu Elhassan No relevant relationships by Safwat Ali Mohammed Eldaaboo