Glucocorticoid pulse therapy in an elderly patient with post-COVID-19 organizing pneumonia: A case report

Abstract

BACKGROUND

Pulmonary fibrosis often occurs as a sequel of coronavirus disease 2019 (COVID-19); however, in some cases, it can rapidly progress, similar to the acute exacerbation of interstitial lung disease. Glucocorticoids are the standard treatment for severe COVID-19 pneumonia requiring oxygen supply; however, the post-COVID-19 efficacy of high-dose steroid therapy remains unclear. Here, we presented a case of an 81-year-old man who developed acute respiratory failure after COVID-19 and was treated with glucocorticoid pulse therapy.

CASE SUMMARY

An 81-year-old man with no respiratory symptoms was admitted due to a diabetic foot. He had been previously treated for COVID-19 pneumonia six weeks prior. However, upon admission, he suddenly complained of dyspnea and required a high-flow oxygen supply. Initial simple chest radiography and computed tomography (CT) revealed diffuse ground-glass opacities and consolidation in both lungs. However, repeated sputum tests did not identify any infectious pathogens, and initial broad-spectrum antibiotic therapy did not result in any clinical improvement with the patient having an increasing oxygen demand. The patient was diagnosed with post-COVID-19 organizing pneumonia. Thus, we initiated glucocorticoid pulse therapy of 500 mg for three days followed by a tapered dose on hospital day (HD) 9. After three days of pulse treatment, the patient's oxygen demand decreased. The patient was subsequently discharged on HD 41, and chest radiography and CT scans have almost normalized nine months after discharge.

CONCLUSION

Glucocorticoid pulse therapy may be considered when the usual glucocorticoid dose is ineffective for patients with COVID-19 sequelae.

Keywords: Coronavirus, Glucocorticoid, Lung disease, Interstitial, Organizing pneumonia, Case report

Core Tip: In cases wherein standard glucocorticoid therapy is ineffective in patients with coronavirus disease 2019 (COVID-19) sequelae, glucocorticoid pulse therapy may be considered. This treatment approach was effective in the present case of an 81-year-old man with post-COVID-19 organizing pneumonia who developed acute respiratory failure after infection. The patient showed significant improvement in oxygen demand and imaging tests after three days of pulse treatment; he eventually recovered without any symptoms of interstitial lung disease. Therefore, glucocorticoid pulse therapy is a potential treatment option for patients with COVID-19 sequelae who require oxygen therapy and do not respond to standard therapy.