PNEUMATOCELE FORMATION FOLLOWING COVID-19 PNEUMONIA: A CASE REPORT

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Cystic lung changes are uncommon but increasingly reported complications following COVID-19 pneumonia. We report a case of COVID-19 pneumonia complicated by large pneumatocele formation. CASE PRESENTATION: A 45-year-old man with no significant medical history presented to the ED with worsening dyspnea a week after testing positive for SARS-CoV2. He was found to be hypoxemic and the chest radiograph showed bilateral opacities consistent with COVID-19 pneumonia. Patient was hospitalized and treated with supplemental oxygen, dexamethasone, remdesivir, convalescent plasma, and tocilizumab. His clinical status improved and he was discharged home after one week of hospitalization. Two weeks later, he presented again with worsening dyspnea and mild hemoptysis. Computed tomography of the chest showed large pneumatocele with focal left lower pneumothorax. Patient was hospitalized and managed conservatively as recommended by pulmonary and cardiothoracic surgery teams. He was discharged in a stable condition and was advised to seek immediate medical attention for concerning respiratory symptoms. DISCUSSION: Pneumatocele is a thin-walled cystic lung change that develops in the setting of pneumonia and is usually transient. Few cases of pneumatocele following COVID-19 pneumonia have been reported. Although it is still controversial, pneumatocele pathogenesis is potentially related to prolonged inflammation causing necrosis in the airways or alveoli with subsequent air leakage. Most of the reported cases were managed conservatively with satisfactory outcomes while the course of few other cases was complicated by development of pneumothorax requiring tube thoracostomy. CONCLUSIONS: Cystic lung changes including pneumatocele should be suspected in patients with new or worsening respiratory symptoms following recovery from COVID-19 pneumonia. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19