Bullous Changes in the Lungs in a Patient After Severe COVID-19 Pneumonia (Case Report and Literature Review)

The global outbreak of COVID-19 has been associated with various complications, including respiratory issues. This study focuses on a clinical case of bullous lung disease observed in a patient following a severe SARS-CoV-2 infection. The rarity of such complications necessitates a detailed investigation to understand the potential cause-and-effect relationships. The case under study involves a 60-year-old woman who contracted COVID-19 in February 2021. She underwent prolonged hospitalization with systemic corticosteroids, antibacterial drugs, anticoagulants, oxygen therapy, and non-invasive ventilation. Multiple diagnostic tools, including X-rays, computed tomography scans, and fibrobronchoscopies, were employed to monitor her condition and identify the development of bullous cavities in her lungs. Initial X-ray examination revealed bilateral polysegmental pneumonia and pneumofibrosis, accompanied by large bullous cavities in the upper lobes of both lungs. Microbiological analyses identified resistant strains of Klebsiella pneumoniae and Pseudomonas aeruginosa. Over the observation period from 2021 to 2023, the patient frequently experienced suppuration and haemoptysis, with no successful eradication of the pathogens. The progressive nature of the disease led to significant deterioration in the patient’s respiratory function and overall health, including the development of pulmonary hypertension and right ventricular heart failure. The formation of bullous cavities in the lungs after COVID-19 may be linked to prolonged inflammatory processes, fibrotic changes, and diffuse alveolar damage. These findings align with other documented cases of bullous lung disease associated with SARS and MERS infections. The study highlights the potential for severe, long-term pulmonary complications following COVID-19, emphasizing the need for continued research into the underlying mechanisms and risk factors. Bullous lung disease presenting after severe SARS-CoV-2 pneumonia is rare and challenging to interpret, particularly due to confounding factors such as secondary bacterial infections and prolonged mechanical ventilation. Although our clinical case does not provide sufficient evidence to establish a direct causative relationship between SARS-CoV-2 infection and bullous pulmonary lesions, it highlights a clinically relevant association warranting further investigation. Clinicians should remain aware of potential pulmonary complications, including bullous changes, in patients recovering from severe COVID-19 pneumonia.