REVERSIBLE LUNG FIBROSIS FOLLOWING SEVERE COVID-19 INFECTIONA CASE REPORT

After wide spread of COVID-19 pneumonia with thousands of cases complicated with acute respiratory distress syndrome (ARDS) of which high percentage fully recovered and resumed their normal life without any disability. It was known that those patients will have residual fibrosis which may affect their daily activity on the long run.There was always paramount question about the reversibility of such fibrosis especially with well-known concept about absence of any radical treatment for such etiology.We present a case of 54 years old male patient, non-smoker with irrelevant medical history apart from well controlled hypertension. He was referred to our facility with fever, productive cough, and shortness of breath. An initial polymerase chain reaction (PCR) screening for SARS-COV2 was positive. A high-resolution CT (HRCT) chest revealed Multi-focal patchy air-space ground glass density with peripheral and basal predominance more affecting the left side, suggestive of viral pneumonia. The patient was commenced on low flow oxygen therapy and symptomatic treatment. Four days later the symptoms aggravated and oxygen requirement increased to non-rebreathing oxygen mask (NRM). We treated him according to COVID protocol withtherapeutic anticoagulation, corticosteroids and oxygen therapy which was adjusted to maintain saturation 92%, but his condition deteriorated and was shifted to intensive care unit. Later patient improved andwas shifted back to the medical ward. We were able to wean him off oxygen and he was discharged home oncorticosteroidsand scheduled for a follow up visit in the pulmonology clinic. Repeated HRCT chest showed regressive course concerning both the airway space disease and the fibrotic changes. The patient returned to his normal life activity with no residual limitation of his physical activity or development of shortness of breath with exertion. Latest HRCT was completely normal.

新型冠状病毒肺炎（COVID-19 pneumonia）广泛传播期间，数以千计的病例并发急性呼吸窘迫综合征（ARDS），其中多数患者完全康复，未遗留任何残疾并恢复正常生活。既往认知认为此类患者会出现残留纤维化，长期可能影响日常活动。一直以来，学界存在一个核心问题：此类纤维化是否可逆？尤其是在针对该病因尚无根治手段的背景下。
本文报告1例54岁男性患者，无吸烟史，既往病史仅存在控制良好的高血压，其余无特殊。患者因发热、排痰性咳嗽、气促就诊于我院。初始严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）筛查结果为阳性。胸部高分辨率计算机断层扫描（HRCT）显示多灶性斑片状实变磨玻璃密度影，以周边及肺底区域为主，左侧受累更为显著，提示病毒性肺炎。
患者初始接受低流量氧疗及对症治疗。4天后症状加重，氧疗需求升级至无重复呼吸面罩（NRM）供氧。遂按照新冠肺炎诊疗方案给予治疗性抗凝、糖皮质激素及氧疗，并调整参数维持血氧饱和度在92%，但患者病情仍恶化，转入重症监护病房。
后续患者病情好转，转回普通内科病房。成功撤除氧疗，患者出院时带用糖皮质激素，并预约至肺科门诊随访。复查胸部HRCT显示气道病变及纤维化改变均呈消退趋势。患者恢复正常日常活动，未遗留体力活动受限，亦未出现劳力性气促。最新一次胸部HRCT检查已完全恢复正常。