When lung and blood meet| Rassegna di Patologia dell'Apparato Respiratorio

Abstract

• 68 years-old male, former smoker (26 P/Y), former truck driver.
• Premature hair graying. No history of any alcohol abuse. No environmental exposure
• Familial clinical history: not relevant.
• Past medical history: not relevant.
• Recent medical history: properly treated Helicobacter Pylori associated chronic gastritis; macrocytic anemia and thrombocytopenia.

In July 2023 he started complaining for asthenia, arthralgia, dyspnea on effort and dry cough.

A CT scan of the thorax documented a coarse nodularity associated with perilobular pattern in the dorsal segment of the right upper lobe, and multiple sub pleural rounded consolidations without air bronchograms, sometimes associated with “halo sign”, in both lower lobes (Fig. 1).

He started a course with steroids and a CT scan performed in October 2023 documented the reduction in number and volume of the lung infiltrates.

In December 2023 the patient presented with respiratory failure needing non-invasive ventilation due to interstitial pneumonia caused by SARS-CoV-2 infection.

He was referred to us with a diagnosis of post-COVID pulmonary fibrosis.

At admission he still claimed for asthenia, arthralgia, dyspnea on effort and dry cough and reported also an episode of hemoptysis in recent past. Fine inspiratory bibasilar crackles were found at the physical examination of the chest. Neurological examination was not relevant. Laboratory tests documented macrocytic anemia, mild thrombocytopenia and mild increase of inflammatory markers. Serum levels of cobalamin, folic acid, glucose and homocysteine were normal. Autoantibodies panel, including those related to inflammatoy myosites/anti-synthetase syndrome and ANCA were negative. Pulmonary function tests revealed mild restrictive pattern and moderate reduction in DLCO. Six minute walking test documented desaturation on effort.