key: cord-0913827-n5avyfez
authors: Combet, Margot; Pavot, Arthur; Savale, Laurent; Humbert, Marc; Monnet, Xavier
title: Rapid onset honeycombing fibrosis in spontaneously breathing patient with Covid-19
date: 2020-07-06
journal: Eur Respir J
DOI: 10.1183/13993003.01808-2020
sha: 7e2c6de4beaece90531b7804ee6dadfb71f91d71
doc_id: 913827
cord_uid: n5avyfez

A 38-year-old man presented with a 6-day history of gradually worsening cough and asthenia and secondary anosmia and agueusia. He had no prior personal medical history. His mother had a history of diabetes mellitus and his son was followed for haemophilia A. His spouse had exhibited similar symptoms a week earlier.

Margot COMBET (1) , Arthur PAVOT (1, 3) , Laurent SAVALE (2, 3, 4) Marc HUMBERT (2, 3, 4) , Xavier MONNET (1, 3, 4) (1) AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France A 38-year-old man presented with a 6-day history of gradually worsening cough and asthenia and secondary anosmia and agueusia. He had no prior personal medical history. His mother had a history of diabetes mellitus and his son was followed for haemophilia A. His spouse had exhibited similar symptoms a week earlier. While in prone position, the patient was no longer tachypnoeic, and required lower levels of oxygen support, allowing us to delay initiating mechanical ventilation.

Over the next few days, prone positioning was regularly performed. Although PaO2 levels were around 75 mmHg on an FiO2 of .8 corresponding to a Horowitz (PaO2/FiO2) ratio of 90, the patient did not exhibit any clinical signs of respiratory distress, no shortness of breath nor tachypnoea. His ROX index [(SpO2/FiO2)/ respiratory rate] 1 remained steadily superior to 5.

Considering the above, mechanical ventilation was therefore not initiated. Fever quickly receded, and inflammatory marker levels decreased. Antibiotics were discontinued on day-4 because of lack of evidence of any secondary bacterial infection. Control CT imaging at day-10 : axial CT images show extensive honeycombing cysts associated with septal thickening, with subpleural predominance (where ground-glass opacities had initially been observed, notably in the right lower and upper lobes), with associated traction bronchiectasis. Pneumomediastinum also developed. There was no sign of pulmonary embolism.

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