Acute Fibrinous Organizing Pneumonia in a COVID-19 Patient: A Case Report
Pailin Ratanawatkul1, Joshua J. Solomon2, Nipon Chaisuriya3, Sasithorn Watcharadetwittaya3, Panaya Tumsatan4, Arunnit Boonrod4, Wipa Reechaipichitkul1, Apichart So-Ngern5, Worawat Chumpangern1, Itthiphat Arunsurat1, Pawornwan Mahawarakorn1, Phitphiboon Deawtrakulchai6, Piroon Mootsikapun7, Songsak Kaitchoosakun8, Chakthip Suttinarakorn9, Napat Yodpinij10, Jeffrey J. Swigris2
Affiliation : 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2 Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA, 3 Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 4 Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 5 Division of Sleep Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 6 Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 7 Division of Infectious and Tropical Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 8 Division of Cardiology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 9 Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 10 Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has varied clinical and radiographic manifestations. Severe initial viral infection, cytokine release, opportunistic infection and post-viral inflammation may all contribute to progressive symptoms and severe lung injury. Acute fibrinous and organizing pneumonitis (AFOP), a rare pattern of acute lung injury characterized by intra-alveolar fibrin ball, has so far been reported associated with infections, connective tissue diseases, drugs and toxins, hematologic malignancy, altered immune status and inhalation injury.
Case Report: The authors report a case of 26-year-old man with severe COVID-19 pneumonia that clinical and radiographic imaging worsened after episode of cytokine storm. The diagnosis of AFOP was confirmed by transbronchial biopsy, and the patient was successfully treated with high-dose corticosteroids.
Conclusion: AFOP can be found in severe COVID-19 patients especially when clinical deterioration occurs later in disease course. Clinical suspicion is needed for prompt diagnosis and treatment. High-dose corticosteroid is an effective medication.
DOI:10.35755/jmedassocthai.2023.S01.13731
Keywords : SARS-CoV-2; COVID-19; Acute fibrinous organizing pneumonia; Respiratory failure; Viral pneumonia; Case report; Acute lung injury
All Articles
Download