key: cord-0968117-elz6pwn3
authors: Mariano, Rachel Zerbini; del Rio, Ana Paula Toledo; Reis, Fabiano
title: Covid-19 overlapping with systemic sclerosis
date: 2020-09-21
journal: Revista da Sociedade Brasileira de Medicina Tropical
DOI: 10.1590/0037-8682-0450-2020
sha: 3e248f928ce32fb1b6ddb4f312b0985c599b36cc
doc_id: 968117
cord_uid: elz6pwn3

nan

www.scielo.br/rsbmt I www.rsbmt.org.br 

Rachel Zerbini Mariano [1] , Ana Paula Toledo del Rio [2] and Fabiano Reis [ A 73-year-old woman with systemic sclerosis (SSc) sine scleroderma presented with Raynaud's phenomenon, esophageal motor disorder with significant dilation, and lung involvement characterized by usual interstitial pneumonia (UIP). Nailfold capillaroscopy revealed a scleroderma pattern. She had antinucleolar autoantibody. The patient was dehydrated, malnourished, admitted to the emergency department, and not taking any immunosuppressants at admission. Real-time polymerase chain demonstrated SARS-CoV-2 infection. A chest computed tomography (CT) revealed right lower lobe consolidation and findings consistent with UIP-predominantly peripheral and basal interlobular septal thickening, reticulations, traction bronchiectasis, and honeycombing ( Figure 1A-C) . A CT scan eight months prior showed no consolidation ( Figure 1D) .

In interstitial lung disease associated with SSc, the most common initiator is injury to alveolar epithelial and vascular endothelial cells; inflammatory pathways activate profibrotic stimuli that produce varying degrees of inflammation and fibrosis. The main interstitial patterns observed are nonspecific interstitial pneumonia and UIP, patterns of which may share some features with Covid-19 pneumonia, such as ground-glass opacities, reticulation, and subpleural lines 1,2 .

CT findings of Covid-19 mainly include, subpleural and predominantly peripheral ground-glass opacities, a crazy-paving pattern, and/or consolidation with air bronchograms, usually with bilateral and multilobar involvement 3 . However, when a patient presents with a pre-existing pathology (such as UIP) comparison with previous CT findings should be done to avoid missing a diagnosis of pulmonary involvement caused by SARS-CoV-2 infection. The presence of interstitial lung disease and ongoing immunosuppressive treatment may place patients with SSc at risk of developing more severe disease and higher mortality when infected by SARS-CoV-2 2 .

Systemic sclerosis and the COVID-19 pandemic: World Scleroderma Foundation preliminary advice for patient management

Severe COVID-19-associated pneumonia in 3 patients with systemic sclerosis treated with rituximab

COVID-19 -Computed tomography findings in two patients in Petrópolis

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

RZM: acquisition of data and writing the initial drafts of the manuscript; APTR: acquisition of data and critical revision. FR: concept, acquisition of data, and critical revision of the manuscript for intellectual content. The authors approved the final version to be published and agreed to be accountable for all aspects of the work.

The authors declare that there is no conflict of interest.