First report on clinical and radiological features of COVID-19 pneumonitis in a Caucasian population: factors predicting fibrotic evolution

Marvisi, Maurizio; Ferrozzi, Francesco; Balzarini, Laura; Mancini, Chiara; Ramponi, Sara; Uccelli, Mario

Abstract Background At the end of February, the Lombardy region (Northern Italy) was involved in the pandemic spread of the new COVID-19. We herein summarize the clinical and radiological characteristics of 90 confirmed cases and analyze their role in predicting the evolution to fibrosis. Methods We retrospectively analyzed the clinical and radiological data of 90 patients with COVID-19 pneumonitis. All subjects underwent an HRCT study on the day of admission and 8 weeks later, and were treated with lopinavir + ritonavir (Kaletra) 400/100 mg 2 times a day or darunavir + ritonavir 2 times a day, and Hydroxychloroquine 200 mg 2 times a day. Pulmonary fibrosis was defined according to the Fleischner Society glossary of terms for thoracic imaging. Results Twenty- three patients developed pulmonary fibrosis (25.5%): 15 were males, whose mean age was 75 ± 15 years. The majority were active smokers (60.8%) and had comorbidities (78.2%), above all hypertension (47.8%) and diabetes (34.7%). Interestingly, in our series of cases “reversed halo sign” is frequent (63%) and seems to be a typical pattern of COVID-19 pneumonitis. The group of patients showing fibrosis had a higher grade of systemic inflammation (ESR and PCR), and appeared to have a bone marrow inhibition with a significant reduction in platelets, leukocytes and hemoglobin. Conclusions To conclude, our data showed that reversed halo sign associated with ground glass pattern may be a typical HRCT pattern of COVID-19 pneumonitis. The evolution to pulmonary fibrosis is frequent in older males and in patients with comorbidities and bone marrow involvement.