COVID-19 pneumonitis and lupus pneumonitis: a challenge in diagnosis and early therapeutic consideration

Abstract

Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It has various clinical manifestations, from asymptomatic to severe disease with possible multi-organ involvement, with respiratory and vascular systems being the frequent affected. COVID-19 can affect patients with autoimmune diseases including systemic lupus erythematosus (SLE). The concurrent of both diseases may show the similar characteristic which can as a challenge in diagnosis and early therapeutic consideration. We report a case of 53 year-old Balinese woman patient who previously diagnosed with acute respiratory iIlness (Pneumonitis), The patient with past history of SLE since 2005, takes 200 mg hydroxychloroquine (HCQ) and 4 mg methylprednisolone once a day orally without adverse effect. Then she was confirmed with SARS-CoV-2 infection (COVID-19 pneumonitis) concurrent with SLE flare (Lupus pneumonitis). The clinical similarities were fever, dry cough and shortness of breath with the chest X-ray (CXR) was bilateral interstitiil infiltrate. Laboratory results; a positive SARS-CoV-2 polymerase chain reaction test, leucophenia, increased ESR, slightly increased CRP, decreased CD4 and CD8 cell count. Decreased oxygen saturation, requiring 4 L of oxygen via nasal cannula on admission. She was given therapy of antibiotics, antivirus and other symptomatic. The prior SLE maintenance therapy was continued with increasing methylprednisolone dose. The patient’s condition was improved and weaned off her oxygen requirements. She was discharged and followed by home isolation for 14 days.