Effect of Early Initiation of Combination Therapy of Anti-Inflammatory and Anti-Fibrotic Drugs on Post COVID-19 Interstitial Lung Disease: A Case Report
DOI:
https://doi.org/10.22317/jcms.v7i3.987Keywords:
Case report, COVID-19, pirfenidone, anti-fibrotic, systemic corticosteroid, macrolideAbstract
The persistence of lung parenchymal changes Post COVID-19 is increasingly recognized as a vital outcome observed on some patients recovering from SARS-CoV2 infection with limited evidence-based management so far. Here we present a 64-year-old male developed extensive interstitial lung changes post SARS-CoV2 infection and was successfully managed with oral prednisone, pirfenidone, and azithromycin maintenance regimen with significant improvement in his clinical and radiographic parameters noted within a relatively short time. The role of a combined therapeutic approach with anti-inflammatory and anti-fibrotic drugs might be provocative action in patients with COVID-19 related interstitial lung disease, especially those at risk for persistent long-term abnormalities and pulmonary fibrosis development.
References
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[3] Ooi GC, Khong PL, Müller NL, et al. Severe acute respiratory syndrome: temporal lung changes at thin-section CT in 30 patients. Radiology. 2004 Mar;230(3):836-44. doi: 10.1148/radiol.2303030853. PMID: 14990845.
[4] Das KM, Lee EY, Singh R, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging 2017: 27(3): 342-349.
[5] Zhang P, Li J, Liu H, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res 2020: 8: 8
[6] Wu X, Dong D and Ma D. Thin-section computed tomography manifestations during convalescence and long-term follow-up of patients with severe acute respiratory syndrome (SARS). Med Sci. Monit 2016; 22: 2793–2799.
[7] Sonnweber T, Sahanic S, Pizzini A, et al. Cardiopulmonary recovery after COVID-19 – an observational prospective multi-center trial. Eur Respir J 2020; in press
[8] Yu-miao Zhao, Yao-min Shang, Wen-bin Song, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine 25 (2020) 100463
[9] Minhua Yu, Ying Liu, Dan Xu, et al. Prediction of the Development of Pulmonary Fibrosis Using Serial Thin-Section CT and Clinical Features in Patients Discharged after Treatment for COVID-19 Pneumonia. Korean J Radiol 2020;21(6):746-755
[10] Yang ZL, Chen C, Huang L, et al. Fibrotic Changes Depicted by Thin-Section CT in Patients With COVID-19 at the Early Recovery Stage: Preliminary Experience. Front Med (Lausanne). 2020 Nov 24;7:605088. doi: 10.3389/fmed.2020.605088. PMID: 33330571; PMCID: PMC7732534.
[11] Jiangping Wei, Hong Yang, Pinggui Lei, et al. Analysis of thin-section CT in patients with coronavirus disease (COVID-19) after hospital discharge Journal of X-Ray Science and Technology 28 (2020) 383–389 DOI 10.3233/XST-200685 IOS Press
[12] Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J 2020; published online May 12. https://doi.org/10.1183/13993003.01217-2020.
[13] Guler SA, Ebner L, Beigelman C, et al. Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. Eur Respir J 2021; in press (https://doi.org/10.1183/13993003.03690-2020).
[14] Carfı A, Bernabei R, Landi F. For the Gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients after acute COVID-19. J Am Med Assoc. 2020;324(6):603e605.
[15] Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021 Feb 25;384(8):693-704. doi: 10.1056/NEJMoa2021436. Epub 2020 Jul 17. PMID: 32678530; PMCID: PMC7383595.
[16] Faverio P, Bini F, Vaghi A, et al. Long-term macrolides in diffuse interstitial lung diseases. Eur Respir Rev. 2017 Dec 6;26(146):170082. doi: 10.1183/16000617.0082-2017. PMID: 29212838.
[17] Ding QL, Lv D, Wang BJ, et al. Macrolide therapy in cryptogenic organizing pneumonia: a case report and literature review. Exp Ther Med 2015; 9: 829–834.
[18] Chang WJ, Lee EJ, Lee SY, et al. Successful salvage treatment of steroid-refractory bronchiolar COP with low-dose macrolides. Pathol Int 2012; 62: 144–148.
[19] Pathak V, Kuhn JM, Durham C, et al. Macrolide use leads to clinical and radiological improvement in patients with cryptogenic organizing pneumonia. Ann Am Thorac Soc 2014; 11: 87–91.
[20] An official ATS/ERS/JRS/ALAT clinical practice guideline: treatment of idiopathic pulmonary fibrosis: an update of the 2011 clinical practice guideline. Am J Respir Crit Care Med 2015;192:e3–e19. Available at http://www.atsjournals.org/doi/abs/10.1164/rccm.201506-1063ST
[21] Flaherty KR, Wells A U, Cottin V et al. Nintedanib in progressive fibrosing interstitial lung diseases. N Engl J Med. 2019;381:1718 27. https://doi.org/10.1056/NEJMoa1908681.
[22] Distler O, Highland KB, Gahlemann M, et al. Nintedanib for systemic sclerosis-associated interstitial lung disease. N Engl J Med. 2019. https://doi.org/10.1056/NEJMoa1903076.
[23] Iyer SN, Gurujeyalakshmi G, Giri SN. Effects of pirfenidone on transforming growth factor-beta gene expression at the transcriptional level in bleomycin hamster model of lung fibrosis. J Pharmacol Exp Ther 1999; 291: 367–373.
[24] Wollin L, Wex E, Pautsch A, et al. Mode of action of nintedanib in the treatment of idiopathic pulmonary fibrosis. Eur Respir J 2015; 45: 1434–1445.
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Published
2021-06-26
How to Cite
Alsilmi, R. (2021). Effect of Early Initiation of Combination Therapy of Anti-Inflammatory and Anti-Fibrotic Drugs on Post COVID-19 Interstitial Lung Disease: A Case Report. Journal of Contemporary Medical Sciences, 7(3), 189–191. https://doi.org/10.22317/jcms.v7i3.987
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