PMC7591954_01
Trends in serum creatine kinase (IU/L) from IMNM diagnosis through his course of COVID-19. First arrow: initiation of concomitant IVIG and mycophenolate mofetil. Second arrow (15 month): the patient's immunotherapies were held, resulting in a rapid return of creatine kinase to levels greater than 5000 IU/L. Third arrow: the patient restarted IVIG and mycophenolate mofetil.
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When we were notified of the high fever, we instructed the patient to stop taking MMF (Figure 1). Unfortunately, his IMNM disease flared (Figure 1) due to weeks of immunosuppression withdrawal. The timing seemed more consistent with cessation of his MMF and IVIG (Figure 1).
Chest radiographs of the patient. (a) Chest radiograph on presentation to the emergency department; the arrows delineate areas of patchy opacities that tend to favor the lung periphery. (b) Scout film from a previous high-resolution chest CT approximately 1.5 years prior to his COVID-19 presentation for comparison.
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His chest X-ray demonstrated multiple patchy opacities in the periphery of both lungs (Figure 2(a)). Three months after the initial infection confirmation, we obtained an additional high-resolution CT of the chest (Figure 2(b)) which showed complete resolution of the interstitial infiltrates and no new areas of fibrosis.
Comparison of coronal images from noncontrast, high-resolution chest computed tomography (CT) before and after COVID-19 pneumonia. (a) demonstrates a coronal slice of the patient's high-resolution chest CT 1.5 years prior to presentation. (b) is a follow-up chest CT 3 months after the patient's recovery from COVID-19 that shows absence of residual pneumonitis or new fibrosis.
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fig3
His IMNM was not previously associated with structural heart or lung disease, and former chest CT was unremarkable a year prior to the current presentation (Figure 3(a)).