INTERSTITIAL LUNG DISEASE EXACERBATED BY NON-NOVEL SARS-COV-2

ABSTRACT

SESSION TITLE Variety in Chest Infections Case Posters SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Viruses are thought to trigger acute exacerbation of interstitial lung disease (AE-ILD) [1]. AE-ILD results in significant morbidity and mortality [1]. We report a case of AE-ILD due to non-SARS CoV2 viral infection in the era of the COVID-19 pandemic. CASE PRESENTATION A 61 year-old African-American male with a history of hypertension, diabetes mellitus, and smoking crack cocaine presented with acute onset of dyspnea, fever, and worsening of his chronic cough. He was diagnosed with ILD suspected to be idiopathic pulmonary fibrosis (IPF) 9 months prior to hospitalization and needed 3 L supplemental oxygen at baseline. He had received 3 doses of COVID-19 vaccination. He was tachycardic, tachypneic, hypoxemic and arrived on a non-rebreather mask to the ED. Physical examination revealed bilateral coarse inspiratory crackles. Laboratory workup revealed leukocytosis, neutrophilia, and lymphopenia. Procalcitonin, lactic acid, BNP, and troponin were normal. CXR showed significantly increased bilateral interstitial markings compared to prior imaging. The patient was not stable for a chest CT. Respiratory pathogen panel was negative for SARS-CoV2, but positive for Coronavirus OC43. Sputum culture grew normal respiratory flora. He continued to have increased work of breathing and was placed on NIV support. He received methylprednisolone, bronchodilators, and ceftriaxone with azithromycin. Antibiotics were discontinued after negative sputum cultures. The patient continued to worsen despite supportive care, he wished to transition the goals of care to comfort only. He was transitioned to hospice care and died within 24 hours. DISCUSSION: Viruses are identified in 10-20% of cases of AE-ILD, in which the virus may be acting as an extrinsic trigger [2]. Efficacious antiviral agents are lacking. Currently, there are no strong evidence based guidelines for the treatment of AE-ILD. Corticosteroids are empirically used to manage exacerbation, however response is variable and particularly worse in the IPF variant of ILD [3]. An effort should be made to identify a treatable infectious etiology in all cases of AE-ILD with any worsening symptoms. Our case highlights that the "common cold” may have fatal consequences for at-risk patients. Care for patients with AE-ILD often goes beyond medications and should encompass emotional and family support. CONCLUSIONS: Hand hygiene and mask wearing are beneficial for ILD patients, in addition to pneumococcal, COVID-19, and influenza vaccinations. In patients with IPF, antifibrotics may help prevent exacerbations [2]. There remains a need for clinical trials to aid in establishing efficacious treatment in AE-ILD. Reference #1 Charokopos A, Moua T, Ryu JH, Smischney NJ. Acute exacerbation of interstitial lung disease in the intensive care unit. World J Crit Care Med 2022;11(1) 22-32 [DOI 10.5492/wjccm.v11.i1.22] Reference #2 Kreuter M, Polke M, Walsh SLF, et al. Acute exacerbation of idiopathic pulmonary fibrosis international survey and call for harmonisation. Eur Respir J 2020;55 1901760 [https//doi.org/ 10.1183/13993003.01760-2019 Reference #3 Jang HJ, Yong SH, Leem AY, et al. Corticosteroid responsiveness in patients with acute exacerbation of interstitial lung disease admitted to the emergency department. Sci Rep. 2021;11(1)5762. Published 2021 Mar 11. doi10.1038/s41598-021-85539-1 DISCLOSURES No relevant relationships by Ibukun Fakunle No relevant relationships by Prajwal Shanker No relevant relationships by Aashish Valvani