Discussion:
Since the initial outbreak of COVID-19, the routine use of CT chest has
been useful in detecting early
parenchymal lung changes suggestive of COVID-19 infection and in
monitoring disease progression,
coinfection, or disease stability 2. Several
radiological features were attributed to be classical of COVID-19
infection. A recent systemic review & meta-analysis of 13 studies
identified the most encountered CT signs of COVID-19 being peripheral
and bilateral lung involvement with ground-glass opacity (GGO) and
consolidation 3.
Bronchiectasis is defined by the presence of permanent and abnormal
dilation of the bronchi with CT
features of bronchus internal diameter larger than that of its
accompanying vessel, lack of bronchial tapering in the periphery of the
chest, and visualization of bronchi in the outer 1–2 cm of the lung
fields 4.
Gram-negative bacteria are the most frequently identified organisms in
the sputum of patients with
bronchiectasis. It has been shown to correlate with disease severity, a
greater decline in lung function,
more frequent exacerbations, and reduced quality of life compared with
other bacteria 5.
Bronchiectasis is not a classical or well-described finding in COVID-19
pneumonia. However, its association has been recently reported. In one
retrospective study, bronchiectatic changes were described in one out of
121 COVID-19 patients 6. Furthermore, a total of four
cases of COVID-19 with bronchiectasis were recently reported as well2,7.
We present a patient with severe COVID-19 pneumonia who developed
progressive bronchiectasis within
4 weeks of symptoms onset. It must be noted that the patient had an
evident superadded bacterial infection with Pseudomonas aeruginosa and
Stenotrophomonas maltophilia which required intravenous antibiotics, and
a prolonged hospital stay with multiple failed attempts to wean off
mechanical ventilation. The complicated course of COVID-19 pneumonia is
an anticipated outcome, however, whether the development of
bronchiectasis is a contributing factor remains unclear. Worth
mentioning, the previously reported cases of COVID-19 induced
bronchiectasis showed a paucity of any superadded bacterial infection.
Despite the lack of baseline CT chest of the patient upon presentation,
being previously healthy without
any preceding hospitalization, non-smoker, unrevealing bronchiectasis
and Tuberculosis (TB) work up
supports the suspicion that his rapidly evolving bronchiectasis is
induced by COVID-19 pneumonia.
In conclusion, the COVID-19 pandemic is a public health emergency,
nonetheless, its long-term pulmonary complication is not well studied.
The pathophysiology, reversibility, and prognostic implication of
COVID-19 associated bronchiectasis require further clinical studies. The
main aim of this study is to highlight the rapid progression of
bronchiectasis as a sequela of COVID-19 infection, which might impact
the prognosis, hence further management, closer follow up and interval
imaging is warranted.