Post COVID Cavitatory Lung Lesions: Individualised Approach

ABSTRACT

Background: A patient presenting with cavitatory lung lesions offers a variety of differential diagnosis to the treating chest physician. It varies from acute and chronic infections, systemic illnesses and malignancy.[1] Arriving at a proper diagnosis and proceeding to next step of management is very challenging. Case Study Case 1 27 male, day 10 of COVID-19 infection, presented with hemoptysis. HRCT Thorax showed bilateral cavitatory lung lesions. Serum Aspergillus IgM and sputum Galactomannan positive. He was started on Injectable liposomal Amphotericin-B. Patient improved. Case 2 48 male, post COVID, presented with breathlessness and headache. He was diagnosed with Right maxillary mucormycosis. HRCT Thorax showed right lung cavitatory lesion. Started on Injectable liposomal Amphotericin-B. The patient underwent Right side Bilobectomy as there was no improvement. Antifungal medications continued and patient improved. Case 3 42 year old male, post COVID, presented with headache and fever and diagnosed as left maxillary mucormycosis. Chest X-ray showed right side cavitatory lung lesion. Started on liposomal Amphotericin-B and Posaconazole. Patient was inoperable as he developed bilateral pneumothorax, for which left sided ICD inserted. Patient improved with antifungal therapy. Discussion: Case 2 required surgical intervention, while case 1 and case 3 improved with medical management. A multidisciplinary team was involved in the management. Early diagnosis is the cornerstone for management. Conclusion: Each patient of post COVID cavitatory lung lesion should be assessed properly and to be treated by individualised approach rather than a generalised approach. Newer antifungals and combination antifungals should be further explored along with surgical management.