The imperative for multidisciplinary follow-up: A case of severe long COVID managed in primary care

Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), presents as persistent multisystemic symptoms beyond 12 weeks post-infection, often affecting elderly patients with comorbidities. This case highlights the need for multidisciplinary primary care management in severe cases involving pulmonary fibrosis. A 76-year-old Caucasian male with hypertension and type 2 diabetes mellitus was hospitalized in December 2020 for COVID-19 with type 2 respiratory failure, pneumonia, and hematological dysfunction. Initial diagnostics included laboratory findings of leukopenia (3.27 × 10⁹/L) lymphopenia (0.71 × 10⁹/L), thrombocytopenia (134 × 10⁹/L), and D-dimer (6.43µg/mL), ferritin (1616ng/mL) and C-reactive protein (6.27mg/L) consistent with inflammatory parameters; chest CT showed bilateral ground-glass opacities, crazy-paving pattern, and 20-25% parenchymal involvement. Treatment involved oxygen therapy, dexamethasone 6 mg intravenously once daily for 4 days, fluticasone-vilanterol inhaler (with initial low adherence), 30mg of gliclazide for glycemic control, and Rivaroxaban was initiated two weeks after discharge at a dose of 15 mg orally twice daily for 21 days, followed by 20 mg orally once daily for a planned total duration of 6 months. Persistent respiratory symptoms from 2021-2022 prompted further evaluation: respiratory function tests revealed mild ventilatory restriction (FEV1 66%, TLC 69%, FEV1/FVC ratio 75%) and moderate CO2 transfer decrease (DLCO 37%, DLCO/VA 66%); follow-up CT indicated nonspecific interstitial pneumonia (NSIP)-like patterns with traction bronchiectasis, basal reticulation, ground-glass opacity, and suspected chronic pulmonary thromboembolism. Lung cryobiopsy and bronchoalveolar lavage in October 2022 confirmed NSIP progressing to usual interstitial pneumonia (UIP) with possible eosinophilic features. Immunosuppression with prednisolone was adjusted in early 2023, alongside antidiabetic optimization. By March 2023, CT angiography and functional tests showed improvement; clinical status stabilized by June 2023. Multidisciplinary follow-up in primary care, involving pulmonology, internal medicine, and physical therapy, monitored symptoms, blood pressure (108-135/65-75 mmHg), HbA1c (stabilized at 6.2%), and ventilatory function. Outcomes included resolution of fatigue, occasional residual cough, improved restriction without new thrombotic events, and enhanced quality of life through rehabilitation. This case underscores the value of proactive, structured post-discharge surveillance, early diagnostic interventions (serial imaging, functional tests, and biopsy), tailored treatments (immunosuppression, anticoagulation, and inhaler therapy), and multidisciplinary coordination in primary care for optimizing outcomes in elderly patients with severe Long COVID and pulmonary fibrosis.