COVID - 19致超敏性肺炎的进展

G. Aftab, M. Ahmad, K. A. Hamid
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引用次数: 1

摘要

慢性肺部疾病患者有发展为COVID - 19严重感染的风险,并且可能预后不佳。然而,关于严重感染COVID - 19后间质性肺疾病(ILD)进展的数据很少。在这里,我们报告了一例已知的ILD(慢性超敏性肺炎)患者,在COVID - 19感染后逐渐恶化。病例报告:一名65岁男性于2018年12月因慢性超敏性肺炎就诊。2017年,他接受了视频辅助胸腔镜手术,当时诊断出肺部的变化是由慢性过敏性肺炎引起的。在我们的临床评估中,患者报告用力时呼吸困难。他双侧有轻微的噼啪声,室内空气饱和度达到94%。先前的CT扫描显示轻度纤维化。该患者被要求来接受随访,但由于COVID - 19大流行,他无法这样做。2020年5月,患者被诊断出患有严重的COVID - 19肺炎,并入院治疗,需要补充氧气。他接受了雷姆德西韦和类固醇治疗,后来靠吸氧出院。出院一个月后复查,患者继续报告呼吸困难和咳嗽加重。此时,胸部重复CT扫描显示肺纤维化恶化。今天,尽管患者已经从COVID-19中康复,但他仍然依赖补充氧气。患者从未吸烟,他是一名来自中美洲的移民,于2016年移居美国。在中美洲,他报告说他家里有一只宠物鹦鹉。讨论:我们怀疑持续接触鹦鹉可能是本患者慢性超敏性肺炎的一个原因。此外,我们的病例报告表明,即使在COVID - 19本身已经治愈之后,COVID - 19也可能导致ILD的进展。由于ILD的普遍患病率(特别是过敏性肺炎)较低,因此对该疾病与COVID - 19的相关性进行了有限的研究。虽然最近的一项研究确实表明,先前存在ILD的成年人患严重COVID - 19的风险增加,但关于COVID - 19感染对ILD患者的长期后果的数据有限。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Progression of Hypersensitivity Pneumonitis Due to COVID 19
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.
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