Лечение пациентов с длительно персистирующими симптомами после перенесенной инфекции COVID-19 является актуальной проблемой для врачей-клиницистов во всем мире. Одним из наиболее значимых проявлений посткоронавирусного синдрома является организующаяся пневмония, для терапии которой в большинстве случаев назначаются глюкокортикостероиды. В работе представлен клинический случай типичного течения пост-COVID-19-организующейся пневмонии у пациента без предшествующей легочной патологии. Обсуждаются факторы риска, принципы диагностики и терапевтическая тактика у данной группы пациентов.
Treatment of patients with long-term persistent symptoms after COVID-19 is an urgent problem for clinicians around the world. One of the most significant manifestations of post-COVID-19 syndrome is organizing pneumonia that is usually treat with corticosteroids. The paper presents a clinical case of typical course of post-COVID-19 organizing pneumonia in a patient without previous lung disease. Risk factors, diagnostic methods and treatment options in this group of patients are also discuss.
1. Wang MY, Zhao R, Gao LJ, et al. SARS-CoV-2: Structure, Biology, and Structure-Based Therapeutics Development. Front Cell Infect Microbiol. 2020;10:587269. DOI:10.3389/fcimb.2020.587269
2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. DOI:10.1001/jama.2020.2648
3. Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55. DOI:10.1111/all.14657
4. Johns Hopkins University & Medicine, Coronovirus Resource Center. Available at: https://coronavirus.jhu.edu/. Accessed 10/21/2021.
5. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus. 6 October 2021. Available at:
WHO/2019-nCoV/Post_COVID-19_condition/Clinical_case_definition/2021. Accessed 10/21/2021.
6. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv. 2021:2021.01.27.21250617. DOI:10.1101/2021.01.27.21250617
7. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55:2001217. DOI:10.1183/13993003.01217-2020
8. Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir Med. 2020;174:106197. DOI:10.1016/j.rmed.2020.106197
9. Zhao YM, Shang YM, Song WB, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463. DOI:10.1016/j.eclinm.2020.100463
10. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232.
DOI:10.1016/S0140-6736(20)32656-8
11. Gulati A, Lakhani P. Interstitial lung abnormalities and pulmonary fibrosis in COVID-19 patients: a short-term follow-up case series. Clin Imaging. 2021;77:180-6. DOI:10.1016/j.clinimag.2021.03.030
12. McGroder CF, Zhang D, Choudhury MA, et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax. 2021:thoraxjnl-2021-217031. DOI:10.1136/thoraxjnl-2021-217031
13. Funk GC, Nell C, Pokieser W, et al. Organizing pneumonia following Covid19 pneumonia. Wien Klin Wochenschr. 2021;133(17-8):979-82. DOI:10.1007/s00508-021-01852-9
14. Hwang DM, Chamberlain DW, Poutanen SM, et al. Pulmonary pathology of severe acute respiratory syndrome in Toronto. Mod Pathol. 2005;18:1-10. DOI:10.1038/modpathol.3800247
15. Yao HM, Zuo W, Wang XL, Zhang W. Findings on cryptogenic organizing pneumonia: a case report and literature review. J Int Med Res. 2020;48(4):300060520920068. DOI:10.1177/0300060520920068
16. Zare Mehrjardi M, Kahkouee S, Pourabdollah M. Radio-pathological correlation of organizing pneumonia (OP): a pictorial review. Br J Radiol. 2017;90(1071):20160723. DOI:10.1259/bjr.20160723
17. Cottin V, Cordier JF. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med. 2012;33(5):462-75. DOI:10.1055/s-0032-1325157
18. Greenhalgh T, Knight M, A'Court C, et al. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026. DOI:10.1136/bmj.m3026
19. Golbets E, Kaplan A, Shafat T, et al. Secondary Organizing Pneumonia After Recovery of Mild COVID-19 Infection. J Med Virol. 2021;94(1):417-23. DOI:10.1002/jmv.27360
20. Corvol H, Alimi A, Prevost B, et al. Atypical severe organizing pneumonia following COVID-19 in an immunocompromised teenager. Clin Infect Dis. 2021;76(2):201-4. DOI:10.1136/thoraxjnl-2020-216088
21. Myall KJ, Mukherjee B, Castanheira AM, et al. Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment. Ann Am Thorac Soc. 2021;18(5):799-806. DOI:10.1513/AnnalsATS.202008-1002OC
22. Okamori S, Lee H, Kondo Y, et al. Coronavirus disease 2019-associated rapidly progressive organizing pneumonia with fibrotic feature: Two case reports. Medicine (Baltimore). 2020;99(35):e21804. DOI:10.1097/MD.0000000000021804
23. Copin MC, Parmentier E, Duburcq T, et al. Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection. Intensive Care Med. 2020;46(6):1124-6. DOI:10.1007/s00134-020-06057-8
24. de Oliveira Filho CM, Vieceli T, de Fraga Bassotto C, et al. Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids. Braz J Infect Dis. 2021;25(1):101541. DOI:10.1016/j.bjid.2021.101541
25. Vadász I, Husain-Syed F, Dorfmüller P, et al. Severe organising pneumonia following COVID-19. Thorax. 2021;76(2):201-204. DOI:10.1136/thoraxjnl-2020-216088
26. Kim DS, Park JH, Park BK, et al. Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features. Eur Respir J. 2006;27:143. DOI:10.1183/09031936.06.00114004
27. Tachikawa R, Tomii K, Ueda H, et al. Clinical features and outcome of acute exacerbation of interstitial pneumonia: collagen vascular diseases-related versus idiopathic. Respiration. 2012;83:20. DOI:10.1159/000329893
28. Park IN, Kim DS, Shim TS, et al. Acute exacerbation of interstitial pneumonia other than idiopathic pulmonary fibrosis. Chest. 2007;132:214. DOI:10.1378/chest.07-0323
29. Horita N, Akahane M, Okada Y, et al. Tacrolimus and steroid treatment for acute exacerbation of idiopathic pulmonary fibrosis. Intern Med. 2011;50:189. DOI:10.2169/internalmedicine.50.4327
30. Inase N, Sawada M, Ohtani Y, et al. Cyclosporin A followed by the treatment of acute exacerbation of idiopathic pulmonary fibrosis with corticosteroid. Intern Med. 2003;42:565. DOI:10.2169/internalmedicine.42.565
31. Song JW, Hong SB, Lim CM, et al. Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011;37:356. DOI:10.1183/09031936.00159709
32. Miyazaki Y, Tateishi T, Akashi T, et al. Clinical predictors and histologic appearance of acute exacerbations in chronic hypersensitivity pneumonitis. Chest. 2008;134:1265. DOI:10.1378/chest.08-0866
33. Suda T, Kaida Y, Nakamura Y, et al. Acute exacerbation of interstitial pneumonia associated with collagen vascular diseases. Respir Med. 2009;103:846. DOI:10.1016/j.rmed.2008.12.019
34. Vadász I, Husain-Syed F, Dorfmüller P, et al. Severe organising pneumonia following COVID-19. Thorax. 2021;76(2):201-4. DOI:10.1136/thoraxjnl-2020-216088
________________________________________________
1. Wang MY, Zhao R, Gao LJ, et al. SARS-CoV-2: Structure, Biology, and Structure-Based Therapeutics Development. Front Cell Infect Microbiol. 2020;10:587269. DOI:10.3389/fcimb.2020.587269
2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. DOI:10.1001/jama.2020.2648
3. Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55. DOI:10.1111/all.14657
4. Johns Hopkins University & Medicine, Coronovirus Resource Center. Available at: https://coronavirus.jhu.edu/. Accessed 10/21/2021.
5. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus. 6 October 2021. Available at:
WHO/2019-nCoV/Post_COVID-19_condition/Clinical_case_definition/2021. Accessed 10/21/2021.
6. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv. 2021:2021.01.27.21250617. DOI:10.1101/2021.01.27.21250617
7. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55:2001217. DOI:10.1183/13993003.01217-2020
8. Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir Med. 2020;174:106197. DOI:10.1016/j.rmed.2020.106197
9. Zhao YM, Shang YM, Song WB, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463. DOI:10.1016/j.eclinm.2020.100463
10. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232.
DOI:10.1016/S0140-6736(20)32656-8
11. Gulati A, Lakhani P. Interstitial lung abnormalities and pulmonary fibrosis in COVID-19 patients: a short-term follow-up case series. Clin Imaging. 2021;77:180-6. DOI:10.1016/j.clinimag.2021.03.030
12. McGroder CF, Zhang D, Choudhury MA, et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax. 2021:thoraxjnl-2021-217031. DOI:10.1136/thoraxjnl-2021-217031
13. Funk GC, Nell C, Pokieser W, et al. Organizing pneumonia following Covid19 pneumonia. Wien Klin Wochenschr. 2021;133(17-8):979-82. DOI:10.1007/s00508-021-01852-9
14. Hwang DM, Chamberlain DW, Poutanen SM, et al. Pulmonary pathology of severe acute respiratory syndrome in Toronto. Mod Pathol. 2005;18:1-10. DOI:10.1038/modpathol.3800247
15. Yao HM, Zuo W, Wang XL, Zhang W. Findings on cryptogenic organizing pneumonia: a case report and literature review. J Int Med Res. 2020;48(4):300060520920068. DOI:10.1177/0300060520920068
16. Zare Mehrjardi M, Kahkouee S, Pourabdollah M. Radio-pathological correlation of organizing pneumonia (OP): a pictorial review. Br J Radiol. 2017;90(1071):20160723. DOI:10.1259/bjr.20160723
17. Cottin V, Cordier JF. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med. 2012;33(5):462-75. DOI:10.1055/s-0032-1325157
18. Greenhalgh T, Knight M, A'Court C, et al. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026. DOI:10.1136/bmj.m3026
19. Golbets E, Kaplan A, Shafat T, et al. Secondary Organizing Pneumonia After Recovery of Mild COVID-19 Infection. J Med Virol. 2021;94(1):417-23. DOI:10.1002/jmv.27360
20. Corvol H, Alimi A, Prevost B, et al. Atypical severe organizing pneumonia following COVID-19 in an immunocompromised teenager. Clin Infect Dis. 2021;76(2):201-4. DOI:10.1136/thoraxjnl-2020-216088
21. Myall KJ, Mukherjee B, Castanheira AM, et al. Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment. Ann Am Thorac Soc. 2021;18(5):799-806. DOI:10.1513/AnnalsATS.202008-1002OC
22. Okamori S, Lee H, Kondo Y, et al. Coronavirus disease 2019-associated rapidly progressive organizing pneumonia with fibrotic feature: Two case reports. Medicine (Baltimore). 2020;99(35):e21804. DOI:10.1097/MD.0000000000021804
23. Copin MC, Parmentier E, Duburcq T, et al. Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection. Intensive Care Med. 2020;46(6):1124-6. DOI:10.1007/s00134-020-06057-8
24. de Oliveira Filho CM, Vieceli T, de Fraga Bassotto C, et al. Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids. Braz J Infect Dis. 2021;25(1):101541. DOI:10.1016/j.bjid.2021.101541
25. Vadász I, Husain-Syed F, Dorfmüller P, et al. Severe organising pneumonia following COVID-19. Thorax. 2021;76(2):201-204. DOI:10.1136/thoraxjnl-2020-216088
26. Kim DS, Park JH, Park BK, et al. Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features. Eur Respir J. 2006;27:143. DOI:10.1183/09031936.06.00114004
27. Tachikawa R, Tomii K, Ueda H, et al. Clinical features and outcome of acute exacerbation of interstitial pneumonia: collagen vascular diseases-related versus idiopathic. Respiration. 2012;83:20. DOI:10.1159/000329893
28. Park IN, Kim DS, Shim TS, et al. Acute exacerbation of interstitial pneumonia other than idiopathic pulmonary fibrosis. Chest. 2007;132:214. DOI:10.1378/chest.07-0323
29. Horita N, Akahane M, Okada Y, et al. Tacrolimus and steroid treatment for acute exacerbation of idiopathic pulmonary fibrosis. Intern Med. 2011;50:189. DOI:10.2169/internalmedicine.50.4327
30. Inase N, Sawada M, Ohtani Y, et al. Cyclosporin A followed by the treatment of acute exacerbation of idiopathic pulmonary fibrosis with corticosteroid. Intern Med. 2003;42:565. DOI:10.2169/internalmedicine.42.565
31. Song JW, Hong SB, Lim CM, et al. Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J. 2011;37:356. DOI:10.1183/09031936.00159709
32. Miyazaki Y, Tateishi T, Akashi T, et al. Clinical predictors and histologic appearance of acute exacerbations in chronic hypersensitivity pneumonitis. Chest. 2008;134:1265. DOI:10.1378/chest.08-0866
33. Suda T, Kaida Y, Nakamura Y, et al. Acute exacerbation of interstitial pneumonia associated with collagen vascular diseases. Respir Med. 2009;103:846. DOI:10.1016/j.rmed.2008.12.019
34. Vadász I, Husain-Syed F, Dorfmüller P, et al. Severe organising pneumonia following COVID-19. Thorax. 2021;76(2):201-4. DOI:10.1136/thoraxjnl-2020-216088
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия
*anastasia.schepalina@yandex
________________________________________________
Larisa A. Akulkina1, Anastasia A. Shchepalina1, Aram A. Kitbalian1,2, Pavel P. Potapov1,2, Alexey S. Moiseev1,2, Mikhail Yu. Brovko1, Victoria I. Sholomova1, Sergey V. Moiseev1,2
1 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 Lomonosov Moscow State University, Moscow, Russia
*anastasia.schepalina@yandex