A Case of Covid ILD with Significant Response to Systemic Steroids

Abstract

The COVID-19 pandemic has resulted in a wide range of clinical presentations, with some patients experiencing persistent symptoms referred to as long haulers. One of the pulmonary complications observed in such patients is Interstitial Lung Disease (ILD). We present the case of a 54-year-old male with a history of childhood asthma who developed ILD following a severe COVID-19 infection. The patient initially required hospitalization, mechanical ventilation and experienced multiple complications including pneumothorax and pneumonia. After discharge, High-Resolution Computed Tomography (HRCT) and Pulmonary Function Tests (PFTs) revealed findings consistent with ILD, specifically a non-UIP pattern on HRCT.

Given the severity of symptoms and lack of definitive treatment guidelines at the time, the patient was started on systemic corticosteroids Prednisone 50 mg daily for two weeks, followed by a taper of 5 mg every five days to a maintenance dose of 10 mg daily. The patient was closely followed in our pulmonary clinic. Notably, systemic steroid therapy led to significant clinical and functional improvement, as evidenced by enhanced lung volumes and gas exchange on PFTs and marked radiographic resolution of interstitial Ground-Glass Opacities (GGOs) and infiltrates on follow-up HRCT.

This case highlights the potential role of systemic corticosteroids in managing post-COVID ILD. Further studies are warranted to establish optimal dosing, frequency and duration of steroid therapy in such patients. This report contributes to the growing body of evidence supporting corticosteroid use in COVID-19-related ILD.