Nintedanib induces rapid remission of steroid-resistant pulmonary fibrosis in an immunocompromised patient with recurrent COVID-19: A case report

Post-COVID-19 lung fibrosis is often treated empirically with corticosteroids; however, established therapeutic options for steroid-resistant cases are lacking. We report the case of a 53-year-old immunocompromised man, with a history of treatment for mantle cell lymphoma, who developed recurrent COVID-19 pneumonia. Despite an initial response to remdesivir and dexamethasone, he experienced six episodes of pneumonia over eight months. This resulted in progressive, steroid-resistant lung fibrosis requiring home oxygen therapy (HOT). Following hospitalization for severe respiratory failure, nintedanib was initiated. A rapid clinical improvement was observed, with decreased oxygen requirements and improved radiological findings within two weeks. After two months of nintedanib therapy, the patient's lung fibrosis had markedly resolved, and he was successfully weaned off HOT. Nintedanib may be an effective therapeutic option for progressive, steroid-resistant lung fibrosis that develops in the context of recurrent or persistent COVID-19, especially in immunocompromised patients.