Authors: Kok Wei Poh, Shobhana Sivandan, Kwee Choy Koh.
ABSTRACT
COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in multiple complications such as long COVID syndrome, pulmonary fibrosis, and organizing pneumonia (OP). Although OP is a well-known complication of COVID-19, several challenges remain; from suspecting and confirming the diagnosis to its management. These challenges are aggravated further in patients who are critically ill and when surgical biopsy is not feasible. Post-COVID-19 OP is a subset of secondary organizing pneumonia that shares similar clinical and radiological characteristics and similar computerized tomography (CT) scan features with OP of various etiologies. In this review, we propose a clinical approach based on current available evidence for the management of COVID-19 patients with suspected OP. Typical CT findings such as consolidations, perilobular opacity, reversed halo sign and ground-glass opacities are highly suggestive of OP, but are not pathognomonic. Confirmation by histopathology should be done but when not possible, a trial of corticosteroid therapy may be considered. However, biopsy should be done if corticosteroid therapy fails or when there is clinical deterioration and worsening of hypoxia while on corticosteroid therapy especially if the onset of the symptoms is longer than two weeks.
Keywords: COVID-19; SARS-CoV-2; organizing pneumonia; corticosteroid; computerized tomography scan
Citations: IEJSME 2022 16 (2): 9-27
