Not all ground-glass opacities are covid

SESSION TITLE: Diffuse Lung Disease Case Report Posters 12 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Since the advent of COVID-19, healthcare professionals have a tendency to link various clinical presentations to it. Herein, we present a post COVID-19 patient with shortness of breath where that bias is uncovered. CASE PRESENTATION: A 27-year-old-female, with a recent diagnosis of COVID-19, presented to the pulmonary clinic with a dry cough and worsening exertional dyspnea, previously treated with inhaled albuterol and fluticasone with no improvement. Prior to her presentation she was hospitalized for similar symptoms. A computed tomography angiogram showed no pulmonary embolism but showed diffuse ground glass opacities (GGOs) bilaterally as well as mediastinal lymphadenopathy. An infectious and autoimmune workup was negative. She was discharged on a 5-day course of Prednisone. Incidentally, she was found to have polycythemia as well. At her clinic visit, pulmonary function tests showed complex restriction with air trapping and reduced transfer factor (DLCO), a repeat CT scan showed persistent GGOs. A bronchoscopy and transbronchial biopsies were performed. Results showed a lymphocytic predominant bronchoalveolar lavage and an elevated Aspergillus galactomannan antigen. Pathology was concerning for cellular bronchiolocentric interstitial pneumonia (BIP). She was started on a steroid taper with symptomatic improvement soon after. DISCUSSION: Bronchiolocentric interstitial pneumonia (BIP) is a subtype of interstitial pneumonia typically seen in females 40-50 years of age. Classic clinical features typically include exertional dyspnea with associated nonproductive cough, and less commonly chest pain or wheezing. PFTs commonly show restrictive lung physiology and gas exchange abnormalities. Findings of BIP on computed tomography (CT) vary from normal to bilateral lower lobe infiltrates and considerable amounts of air trapping. Before being labelled as BIP, one must consider autoimmune diseases, inhalational injuries, or drug reactions that can have similar patterns of lung injury.Histologically, BIP is represented by a centrilobular and peribronchial inflammatory pattern accompanied by lymphocytic infiltrates without granulomatous features which is identical to hypersensitivity pneumonitis (HP) apart from absent granulomatous' features. However, newer evidence has shown that only 60-80% of HP cases present with granulomas on histology. Treatment includes cessation of the offending agent if present and the addition of systemic steroids. Multiple past reviews have shown poor prognosis due to delayed recognition and treatment. CONCLUSIONS: In summary, BIP should be considered as a separate entity in the classification of idiopathic interstitial pneumonias given its distinct clinical, radiological, and histopathological findings. While it may be argued that this disease lies on the spectrum of hypersensitivity pneumonitis, more research will help delineate and define this disease entity. REFERENCE #1: Yousem A, Samuel MD. Idiopathic BronchiolocentricInterstitial Pneumonia. Modern Pathology (2002); 15: 1148–1153 REFERENCE #2: Reyes CN, Wenzel FJ, Lawton BR, et al. The pulmonary pathology of farmer's lung disease. Chest 1982; 81: 142–146. REFERENCE #3: Ando M, Arima K, Yoneda R, et al. Japanese summer-type hypersensitivity pneumonitis: geographic distribution, home environment, and clinical characteristics of 621 cases. Am Rev Respir Dis 1991; 144: 765–769. DISCLOSURES: No relevant relationships by Tiffany Dumont No relevant relationships by Chelsea Ledgerwood No relevant relationships by Adeel Nasrullah No relevant relationships by Sitara Niranjan No relevant relationships by Sheldon Rao No relevant relationships by Matthew Simpson