Development of Cavitary Lung Disease as a Long-term Complication of Coronavirus Disease 2019 in a Young Previously Healthy Patient

A Case Report

Goar Egoryan; Elise Hyser; Ammar H. Mushtaq; Maria Adriana Yanez-Bello; Daniela Patricia Trelles-Garcia; Harvey J. Friedman; Guillermo Rodriguez-Nava

Disclosures

J Med Case Reports. 2021;15(377) 

In This Article

Discussion and Conclusion

We present a young, healthy adult who developed cavitary lung disease 6 months after mild COVID-19 illness. To date, documented cases of cavitary lung disease secondary to COVID-19 have been reported in the acute or subacute phase of the infection. A 27-year-old man hospitalized with COVID-19 was found to have cavitation in the apical segment of the lower lobe of the lung,[8] and a case series described 12 patients with severe COVID-19 that developed lung cavitation during the acute phase of the illness.[11] One case reported a 37-year-old man who developed multiple small lung cavities 2 weeks after convalescence from COVID-19,[10] while another case report described a 34-year-old male diagnosed with a large lung cavity 2 weeks after being discharged from the hospital.[3] Furthermore, a 52-year-old male developed a lung cavity 3 weeks after the diagnosis of COVID-19 was made.[7] Lastly, two 59-year-old men were reported to develop spontaneous large pulmonary cavities 1 month after COVID-19.[9] Hence, clinicians should be aware of cavitary lung disease as an acute and late complication of COVID-19.

Cavitation is one of the least frequent complications in COVID-19, and appropriate differential diagnosis workup should be done before tying cavity development to COVID-19.[12,13] Other processes, such as bacterial superinfection or coinfection with Mycobacterium tuberculosis, should be ruled out.[14–16] In our case, an extensive workup was performed, and given the fact that our patient had no previous significant comorbidities, it was concluded that his cavitary lung disease was a long-term complication of COVID-19.

The cavitation mechanism in COVID-19 is unknown and may result from intense inflammatory response leading to diffuse alveolar damage, intraalveolar hemorrhage, and necrosis of parenchymal cells.[17,18] It is worth mentioning that our patient had just a mild course of COVID-19, and nevertheless, he developed a significant lung sequela. Further studies are needed to understand the exact pathophysiologic mechanism underlying cavitary lung disease as an acute and late complication of COVID-19.

To date, there is no consensus on how post-COVID-19 cavities should be managed. Most of the few reported cases have been managed medically, with only one case reporting excision of infected pneumatoceles.[19] Our patient failed medical therapy alone and was required to undergo surgery combined with prolonged antibiotic therapy, highlighting the importance of a multidisciplinary approach in patients with COVID-19.

In conclusion, we present the case of a young adult who developed cavitary lung disease 6 months after a mild COVID-19 illness who failed medical therapy alone but was later successfully treated with combined surgical and medical therapy. Hopefully, as the pandemic unfolds, the whole range of long-term health effects associated with COVID-19 will be elucidated, and appropriate treatment guidelines for managing these complications, including cavitary lung disease, will be developed.

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