ACCELERATED GRANULOMATOUS LYMPHOCYTIC INTERSTITIAL LUNG DISEASE DUE TO COVID-19 IN A PATIENT WITH COMMON VARIABLE IMMUNODEFICIENCY PRESENTING WITH RECURRENT PNEUMOTHORACES

ABSTRACT

SESSION TITLE Post-COVID-19 Infection Complications SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: Patients with COVID-19 usually recover completely in the acute setting but it has been demonstrated post-infectious complications include continued dyspnea, myalgias, and other long-term complications which are not fully known yet. A case published in the British Medical Journal by Nunna demonstrated the development of a large spontaneous pneumothorax in a middle-aged patient after his Covid-19 infection [1]. Here, we present a 60-year-old female with a history of common variable immunodeficiency (CVID) and hypothyroidism presenting with recurrent pneumothoraxes as a late complication of COVID-19. CASE PRESENTATION A 60-year-old female with a history of CVID and COVID-19 pneumonia complicated by chronic hypoxic respiratory failure and a right sided loculated hydropneumothorax diagnosed in December of 2020, on 3 to 5 liters of home oxygen, presents to the emergency department due to dyspnea and left-sided pleuritic chest pain in July of 2021. On presentation, the patient was tachypneic, had labored breathing and was requiring 7 liters of oxygen to saturate adequately. Repeat imaging of the chest showed a large tension pneumothorax on the left side with near complete collapse of the lung and tracheal deviation to the right [figure 1]. At that time, a chest tube was placed to re-expand the lung. After 5 days of treatment, repeat imaging showed marked improvement, with the pneumothorax decreasing significantly [figure 2]. Pulmonary function testing in the outpatient setting showed a moderate restrictive lung defect with sever decrease in diffusion capacity. The patient continued to have dyspnea so, the decision was made for the patient to undergo an open lung biopsy. The pathology report showed noncaseating granulomas with focal interstitial fibrosis and lymphocytic infiltrates consistent with granulomatous lymphocytic interstitial lung disease (GLILD), which is a complication of CVID [figure 3]. Roughly 1 in 5 patients with CVID develop histopathological findings consistent with GLILD[2]. We believe these changes were accelerated due to her COVID-19 infection. DISCUSSION: This case habits the importance of continued consideration for long-term complications of COVID-19, especially in patients who are immunocompromised. Reports of diffuse alveolar injury caused by the virus can result in emphysematous changes ultimately leading to alveolar rupture such as in this patient [3]. Although pneumothorax is an uncommon late complication, it should be on the differential diagnosis for COVID-19 patients with sudden respiratory decompensation. As a life-threatening event, it requires prompt recognition and treatment. CONCLUSIONS: Patients who have CVID complicated by GLILD accelerated by COVID-19, are more prone to life-threatening tension pneumothoraxes and they should be encouraged to seek lung transplantation as this could be the only way to stop the formation of these pneumothoraxes. Reference #1 Nunna, K., & Braun, A. B. (2021). Development of a large spontaneous pneumothorax after recovery from mild COVID-19 infection. BMJ Case Reports, 14(1), e238863. Reference #2 Granulomatous and Lymphocytic Interstitial Lung Disease (GLILD) A Spectrum of Pulmonary Histopathological Lesions in Common Variable Immunodeficiency (CVID) - Histological and Immunohistochemical Analysis of 16 cases. (n.d.). Reference #3 Gradica, F. (2020). Spontaneous Pneumothorax in Covid-19 Pneumonia. Case report. Clinical Orthopaedics and Trauma Care, 2(1), 01–03. https//doi.org/10.31579/2694-0248/010 DISCLOSURES No relevant relationships by Elizabeth Bankstahl No relevant relationships by Talal Bazzi No relevant relationships by Mujtaba Cherri No relevant relationships by Khairya Fatouh