Organizing Pneumonia Treated with High-Dose Methylprednisolone in an Adolescent with COVID-19 Pneumonia Under Extracorporeal Membrane Oxygenation

Abstract

A 16-year-old boy was admitted to our pediatric Intensive Care Unit with moderate acute respiratory distress syndrome (ARDS) due to coronavirus disease-2019 (COVID-19) pneumonia. There were no comorbidities excluding class II obesity (body mass index = BMI 36 kg/m²). He received dexamethasone, tocilizumab, and non-invasive respiratory support via high-flow nasal cannula and non-invasive positive pressure ventilation combined with awake prone positioning. After 16 days, he progressed to severe ARDS with need of endotracheal intubation and venous–venous extracorporeal membrane oxygenation (ECMO). Because of radiological appearance of progressive bilateral pulmonary basal consolidation, cryptogenic organizing pneumonia was suspected. In addition to continuing prone positioning under ECMO therapy, a systemic glucocorticoid therapy with 2 mg/kg body weight (BW), prednisolone was started over 3 days but failed to improve pulmonary function sustainably. Subsequently, the patient showed excessive patient-ventilator-asynchronies and was put on neurally adjusted ventilatory assist ventilation by day 63. Despite continuation of a glucocorticoid therapy, bilateral pulmonary consolidations progressed and new cystic conversions of lung tissue appeared on computed tomography (CT) scan with persisting respiratory failure. Therefore, on day 80, a high-dose methylprednisolone therapy of 10 mg/kg BW was initiated under which respiratory function rapidly improved and ECMO therapy could be terminated by day 84. On day 110, the patient was successfully discharged to rehabilitation without neurological deficit.