(Kiosk 7) Weakness in the Setting of Organizing Pneumonia After COVID-19: A Case Series

Case Diagnosis: Case 1: An 80 year old male with mantle cell lymphoma presenting after a recent admission for COVID-19 with severe weakness secondary to organizing pneumonia.
Case 2: A 72 year old male with acute myelogenous leukemia presenting with fatigue and shortness of breath found to have post-COVID organizing pneumonia.

Case Description or Program Description: Case 1: An 80 year old male with mantle cell lymphoma and recent COVID-19 presented to acute care from home with weakness. CT chest showed evidence of organizing pneumonia. High dose steroids were initiated. On discharge to IPR, he required up to 4L of oxygen with exertion. He was at a mod to max assist level for transfers and gait.
Case 2: A 72 year old male with acute myelogenous leukemia and recent COVID-19 presented to acute care from home with weakness and shortness of breath. CT chest revealed evidence of organizing pneumonia. Treatment with high dose steroids was initiated. On discharge to IPR, he required up to 3L with exertion. He was at a min assist level for transfers and gait.

Setting: Inpatient Rehabilitation (IPR)

Assessment/Results: Both patient’s rehabilitation courses sought to improve endurance, mobility, and strength via intensive cardiopulmonary rehabilitation. Specific cardiopulmonary interventions included inspiratory and expiratory muscle training, diaphragmatic breathing techniques, and energy conservation. On discharge, patient 1 required no oxygen with exertion and was at a supervision level for transfers and gait. Patient 2 required up to 2L on exertion and was at a setup to independent level for transfers and gait.

Discussion (relevance): Organizing pneumonia is a rare condition characterized by lung damage with diffuse interstitial changes. High dose steroids are the mainstay of treatment. Intensive cardiopulmonary rehabilitation is imperative to maximize functional outcomes in this patient population.

Conclusions: These cases highlight a rare debilitating sequela of acute COVID infection and how intensive cardiopulmonary rehabilitation can improve functional outcomes.