Worsening of a progressive interstitial lung disease in a patient with adult Still's disease after a novel coronavirus infection

Abstract

Adult Still's disease is a rare systemic disorder of unknown etiology. Its course is often complicated by interstitial pneumonia and fulminant hepatitis. Published data have indicated some common mechanisms of systemic inflammation in patients with autoimmune disorders and SARS-COV-19. We present a clinical case of a 74-year old female patient with a long standing, slowly progressive Stills disease, who developed honeycomb lung and severe liver injury as major syndromes after a novel coronavirus infection. Within 10 months, she developed increasing dyspnea, progressive fibrous pulmonary abnormalities with formation of a "honeycomb lung" and signs of liver failure. Due to late medical referral, these symptoms have led to the patients death. According to the literature, lung tissue abnormalities that persist after a new coronavirus infection in patients with autoimmune disorders can be both a manifestation of residual post-covid injury and a systemic disease-associated lung injury with COVID-19-triggered progression. By this clinical example, we intended to illustrate that the key to a correct diagnosis is multiple organ damage persisting after a novel coronavirus infection irrespective of the severity of the coronavirus lung injury. Such symptoms indicate the need to assess immunological markers to exclude an autoimmune disease exacerbation or onset. Clinicians should aim at rapid diagnosis and timely initiation of specific therapy.

Keywords

• adult still's disease
• nonspecific interstitial pneumonia
• “honeycomb lung”
• covid-19
• systemic connective tissue disorders