Concluded Case

Post covid19 pneumonia case

65yr/M Post covid19 discharge K/c/o DM@HTN Hospitalization treatment recieved Methylprednisolone/clexane/fabiflu Hqn/remdesivir 8 inj/ivermectin/ Piptaz antibiotics/plasma therapy Post discharge Insulin with OHA Anti HTN Anticoagulant Blood reports all normal.. CBC/CRP/LFT/RFT Reducing ddimer (2800-1450-900) Present status Fluctuating sugar Vitals stable Spo2 at rest & after exercise@97-98 Pulse bp maintained No fresh complaints Performing well his daily activities Now the point is.. Abt ptn CXR been attached 9th&16th Oct Pulmonary changes was seen.. Increased opacity from left lower zone To bilateral..(within a week time) This pulmonary progression is it due To fibrosis or some other reason opacity which will be required to evaluate Secondly would like to know how this case progression will be or further prognosis will be Thirdly how this term covid19 pneumonia Which is used mostly Can be defined Case is for my reference for my knowledge to understand.. I would be happy to know from respected drs their views and Suggestions..

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Thanx dr Sandeep Ss tagging me Ans to your questions 1 xray chest both are identical i can see airspace change bilaterally hence it looks to be status co. Yes it is resolving interestial fibrosis Adv steaming frequently Spirometry No active exercises or exertion for further 2months 2 prognosis will be progressive and healthy need to keep followup I will adv to continue or start pirfenidone 200mg 2tds for 1month 3covid19 pneumonia is misnomer and is being used as blanket term as we can't see any alveolar damage or posthumously detected Hence swellings or haziness seen of covid19 SARS 2 is is GGOs only which get resolved and as changes are inflammatory lands in fibrosis

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Thanx dr Sandeep Ss tagging me Ans to your questions 1 xray chest both are identical i can see airspace change bilaterally hence it looks to be status co. Yes it is resolving interestial fibrosis Adv steaming frequently Spirometry No active exercises or exertion for further 2months 2 prognosis will be progressive and healthy need to keep followup I will adv to continue or start pirfenidone 200mg 2tds for 1month 3covid19 pneumonia is misnomer and is being used as blanket term as we can't see any alveolar damage or posthumously detected Hence swellings or haziness seen of covid19 SARS 2 is is GGOs only which get resolved and as changes are inflammatory lands in fibrosis

I'm greatly thankful to u dr for ur advise.im being great fan of urs on this curofy..ur advises in different cases I do follows..infact u resolved all my doubts.. wonderful sir..
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Tapering steroids dose Bronchodilators Oral anticoagulation therapy would be great helpful in avoiding post covid complications like thromboembolism, fibrosis etc. Anyways pt is not hypoxemic. Opacities will take some time to resolve. If still fibrosis persisted or clinical deterioration observed, may consider antifibrotics.

Thanku dr for ur valuable opinion..
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Patchy opacities are seen but its better to get a CT done to see the extent of involvement... Patient is diabetic and Hypertensive.. Systemic Steroids for long would not be a good choice.... Give conservative treatment and follow up

Steroids r off.. HRCT would surely be considered..truly thankful to u for ur advise..thanks..
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Similiar pattern is seen in few of our patients too. Post covid that is around 14 days of first symptom patient though improving clinically cxr deterioating.. I think fibrotic changes will keep on going. For one patient we repeated CT after 3 months few basal changes remained but cxr was normal.

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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Agree with Dr Shivraj Agrawal

Thank you doctor
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Looks like post-COVID-19 Sequel ? Early fibrosis this patient may require steroids tapering next 10 to 12 week plus bronchodilators plus incentive spirometry plus anticoagulant since the d dimer is still raisedRepeat x-ray after four weeks for comparison

Covid pneumonia progression

Thank you doctor
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I AGREE WITH @Dr. Shivraj Agarwal & @Dr. Hardik Ahuja

Thank you doctor
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Patchy atelectetic change in bilateral lungs ....COVID

Thanks dr for ur suggestion.with due respect how would u advise in such cases to keep follow up with xray or HRCT..though clinically stable..
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