Synergistic effect of sars-cov-2 infection and pulmonary asbestosis

SESSION TITLE: Occupational and Environmental Lung Diseases Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: By mid-2022, almost 85 million Americans had been infected by SARS-CoV-2, with approximately 1 million death ascribed to the pandemic. Mortality has seen a significant improvement increased vaccination. However, as seen in our case, even the full course of vaccinations may not be enough to prevent the development of respiratory failure in patients with certain rarely thought-of but still high-risk lung conditions such as pulmonary asbestosis. CASE PRESENTATION: 83-year-old male with a past medical history of hypertension, hyperlipidemia, and asbestosis-related pleural disease presented with shortness of breath requiring supplemental oxygen to keep blood oxygen saturation > 92%. He had a history of mild calcified and non-calcified pleural plaques which appeared to have progressed on the CT scan done on admission. There was otherwise no parenchymal lung involvement. He tested positive for COVID. He had received two doses of COVID vaccinations along with booster doses. He was treated with IV remdesivir and dexamethasone 6 mg daily for 10 days despite which his oxygen requirement continued to worsen and he was intubated. A repeat CT scan showed bilateral ground glass opacities consistent with severe COVID-19 infection along with bilateral mild pleural effusion and worsening of pleural plaques. After aggressive diuresis he was extubated to high-flow oxygen but failed to progress further and eventually pursued comfort-directed care, expiring in the hospital shortly thereafter. DISCUSSION: Inhalation of asbestos fibers can cause pleural and parenchymal lung disease which can lead to fibrosis or neoplasm. Asbestos increases oxidative stress which activates persistent low-grade inflammation which can manifest after a latency period of more than 15 years. SARS-CoV-2 is an RNA virus that affects lung parenchymal cells. In severe cases, pneumonia occurs, and the worst prognosis is associated with the activation of severe inflammatory response leading to acute respiratory distress syndrome. Asbestos exposure is associated with severe COVID-19 due to immune alteration and an underlying inflammatory state. Patients with asbestosis should be cautioned to take extra care to limit their exposure. CONCLUSIONS: Due to underlying lung disease and inflammatory state asbestosis is associated with worse outcomes in COVID-19. Patients with pulmonary asbestosis should be counseled about their high risk. REFERENCE #1: Granados G, Sáez-López M, Aljama C, Sampol J, Cruz MJ, Ferrer J, Se-Covid-Team. Asbestos Exposure and Severity of COVID-19. Int J Environ Res Public Health. 2022 Dec 6;19(23):16305. doi: 10.3390/ijerph192316305. PMID: 36498378; PMCID: PMC9739528. REFERENCE #2: Granieri A, Bonafede M, Marinaccio A, Iavarone I, Marsili D, Franzoi IG. SARS-CoV-2 and Asbestos Exposure: Can Our Experience With Mesothelioma Patients Help Us Understand the Psychological Consequences of COVID-19 and Develop Interventions? Front Psychol. 2020 Dec 22;11:584320. doi: 10.3389/fpsyg.2020.584320. PMID: 33414743; PMCID: PMC7782241. DISCLOSURES: No relevant relationships by Mobeen Ahmad No relevant relationships by Fnu Aisha No relevant relationships by Margaret Mack No relevant relationships by Rahat Memon No relevant relationships by Hamza Muhammadzai No relevant relationships by Ifrah Naeem No relevant relationships by Kimberley Okoyeze No relevant relationships by Patrick Ottman No relevant relationships by Rehan Saeed No disclosure on file for Michal Tokarski