Via Research Recognition Day 2024 VCOM-Carolinas

Clinical Case-Based Reports

COVID-19 or Cancer? Rayhan Karimi, OMS-III, Arun Adlakha, M.D. VCOM Carolinas, Spartanburg, SC.

Purpose: To increase medical knowledge, treatment, and patient presentation of COVID-19 PIPs

Abstract

Case Report

Histology

• Patient presented to p s o y s m t r i h t e i p e s v t p e E o i Cm R ra O s w t V o a i I r t n D y h d - 1 a 9 test. • Psattai enndtacrodmC Op lVeItDe d treatment. d g r SOB. • Lung biopsy showed gi rnaf nl auml ommaat ti oo nu .s •d soTtshaere toepf dapt ori eenndatn lwi os aon sng e taper. • sOt rener dor eiudpcset )iao, ttnhC ieXnrRem(wap aso sss ta sizes. f adt•iegTvuehel eo, appnea ddt i ewf enevt iegrh, t loss. • Sputum cultures revealed Mycobacterium tuberculosis. • Anti-TB medication regiment. p u h e i a n c a , t g e s s mx u p • h m u u T i c t b m h u o i e m t i e d e r f , d , o p c t l i h r o l n o o e u c w

Introduction § Pulmonary inflammatory pseudotumors (PIP) are cc ehlal sr ,aac ct ec roimz epda bn yi e ad pbryoal inf eirnaftl iaomn mo fa mt oyr oy fiinbfriol tbr laatset iocf sppl ai ns dml ea cells, lymphocytes, histiocytes and eosinophils. § These lesions usually occur after recovery of an infection and comprise about .4-.12% of all pulmonary masses. the left anterior lobe. A lung biopsy was performed, which showed histiocytic aggregates and other features consistent with granulomatous inflammation. Considering the inflammatory nature of the bilateral upper lung masses, the patient was placed on a slow prednisone taper course. CXR (post steroids) showed a marked decrease in size of the masses with signs of scarring. The patient's symptoms recurred in 2023, prompting further investigation. Extensive bilateral cavitary lung disease was discovered, and Mycobacterium tuberculosis was identified in sputum cultures. This led to initiation of anti-tuberculosis therapy. The patient is currently on observed therapy, showing improvement in respiratory and constitutional symptoms. A 58-year-old male with a history of COPD, emphysema, and anxiety, presented to the ER exhibiting respiratory symptoms, fever, and a positive COVID-19 test. A CXR revealed bilateral, peripheral, patchy airspace opacities. Standard COVID-19 treatment was enacted, and he was subsequently discharged in good health. He remained clinically stable until the summer of 2022 where he noted increasing mucoid productive sputum, cough, and SOB. A CTA chest was performed and a new right upper lobe spiculated consolidation was noted along with left cystic consolidations in Diagnosis gDr ua ne ut ol otmh ea tporuess, ehni tsitni og ciyl ltni ce si ns fol af mC OmVaItDo -r1y9mwaistshe ss u, tbhsies qpuaet ni et n t was diagnosed with: § Currently, treatment options include surgical resection, corticosteroids, and radiation therapy. § Patients who are immunosuppressed are at a higher risk of developing symptomatic reactivation tuberculosis. COVID-19 PIPs

Figure 6. poorly formed granuloma comprised of histiocytes and lymphocytes

COVID-19

Figure 1. CXR showing bilateral peripheral patchy airspace opacities

n e d g t

t a s i i e i n v n

Figure 7. Poorly formed granuloma with focal area of necrosis

POSTPICPOVID

Figure 2 and 3. CTA chest showing a cystic consolidation in the anterior left lobe and a spiculated consolidation in the right upper lobe

Conclusions

• This is one of the first documented cases of post COVID-19 PIPs and displays a new complication of the virus. • Patients who develop masses after COVID-19, a lung biopsy should be done to rule out a PIP. • In reflection of this case, patients with post COVID-19 PIPs can be started on a prednisone taper as first line therapy. • s tPe ar ot iiednct os uwr hs eo sahr oe upl odsut nCdOeVrIgDo- 1a 9Q auna dn tai Fr eE Rc aOnNd ibdl aotoeds tf eo sr t at o rule out latent TB before initiation.

RESOOFLPUITPsION

Figure 4. CXR showing reduction in mass size and signs of scarring

ROEF ALCATTI EV NA TT I OT BN

Acknowledgements and References

Figure 5. CTA chest showing progressive bilateral cavitary disease

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2024 Research Recognition Day