Progression of Hypersensitivity Pneumonitis Due to COVID 19

Abstract

Introduction:Patients with chronic lung disease are at risk of developing severe COVID 19 infection, and are likely to have poor outcomes. There is, however, little data available on the progression of interstitial lung disease (ILD) after severe COVID 19 infection. Here, we present the case of a patient with known ILD (chronic hypersensitivity pneumonitis, in this case), which progressively worsened after COVID 19 infection.Case Report:A 65 year old male presented to our clinic for management of chronic hypersensitivity pneumonitis in December 2018. In 2017, he had a video assisted thoracoscopic surgery performed, when it was diagnosed that the changes in his lungs were due to chronic hypersensitivity pneumonitis. On evaluation in our clinic, the patient reported dyspnea on exertion. He had mild crackles bilaterally and was saturating 94% on room air. A prior CT scan showed mild fibrosis. The patient was asked to come for a follow-up, but he was unable to do so due to the COVID 19 pandemic.In May 2020, the patient was diagnosed with severe COVID 19 pneumonia, and was admitted into the hospital, where he required supplementary oxygen. He was treated with Remdesivir and steroids, and was later discharged home on oxygen. When the patient was examined one month after discharge, he continued reporting worsening dyspnea and cough. At this time, a repeat CT scan of the chest showed worsening pulmonary fibrosis.Today, even though the patient has recovered from COVID-19, he remains dependent on supplementary oxygen.The patient has never been a smoker;he is an immigrant from Central America, having moved to the US in 2016. Back in Central America, he reported having a pet parrot in his home.Discussion:We suspect that continued exposure to the parrot may have been a cause of chronic hypersensitivity pneumonitis in our patient. Further, our case report indicates that COVID 19 may cause progression of ILD even after COVID 19 itself has been cured.Since the prevalence of ILD in general (and hypersensitivity pneumonitis in specific) is low, limited research has been carried out on the correlation of this disease with COVID 19. While a recent study did indicate that adults with preexisting ILD were at an increased risk of severe COVID 19, limited data is available on the long term consequences of COVID 19 infection for ILD patients.