• Beti Zafirova Ivanovska Institute for Epidemiology ,Biostatistics and Medical Informatics, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R.North Macedonia
  • Jagoda Stojkovikj University Clinic of pulmonology and allergology, Medical Faculty, Ss Cyril and Methodius University in Skopje, R. North Macedonia


 A large number of hospitalized COVID-19 survivors show that persistent symptoms, radiographic abnormalities and physiological impairments exist months after the initial illness. Persistent chest imaging abnormalities and histopathological findings of lung fibrosis were also found in a majority of survivors of the SARS-CoV-1 suggesting that the SARS viruses may lead to a worse fibroproliferative response than other pneumonia. Our patient had a severe COVID-19 pneumonia, followed by massive infiltrative changes in both lungs in addition to massive pulmonary fibrosis. After the initial treatment in one of the COVID-19 centers in the Clinical Center in Skopje, the patient with post-COVID-19 (more precisely pulmonary fibrous changes of the lungs) was referred for further treatment to the University Clinic for Pulmonology in a severe clinical condition, where he was treated at an outpatient basis in the period of several months. During that time the condition improved, with a significant withdrawal of the X-ray finding of the lungs, which was registered on CT from 5.5.2021. He is still under observation. The robust responses of corticosteroid therapy in our case presenting a radiological pattern of organizing pneumonia allowed the patient to return to his baseline clinical condition. But due to the persistence of X-ray residual changes he is under our regular observation.

Keywords: COVID-19, bilateral pneumonia, massive pulmonary fibrosis.


1. McGroder CF, Zhang D, Choudhury MA, et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax 2021;(76):1242–1245
2. Lechowicz K, Drozdzal S, Macha F, Rosik, J, Szostak, B, Zegan-Baranska J et al. COVID-19: The potential treatment of pulmonary fibrosis associated with SARS-CoV-2 infection. J Clin Med. 2020 Jun 19; 9(6):1917.
3. Deng, L.; Khan, A.; Zhou, W.; Dai, Y.; Md, E.; Chen, R.; Cheng, G. Follow-up study of clinical and chest CT scans in confirmed COVID-19 patients.Radiol. Infect Dis.Sep;7(3):106-113.
4. Huang, W.; Wu, Q.; Chen, Z.; Xiong, Z.; Wang, K.; Tian, J.; Zhang, S. The potential indicators for pulmonary fibrosis in survivors of severe COVID-19. J. Infect. 2021 feb;82(2): e5-e7
5. Salisbury ML, Lynch DA, van Beek EJR, et al. Idiopathic pulmonary fibrosis: the associateion between the adaptive multiple features method and fibrosis outcomes. Am J Respir Crit Care Med 2017;(195):921–9.
6. McElvaney, O.J.; McEvoy, N.L.; McElvaney, O.F.; Carroll, T.P.; Murphy, M.P.; Dunlea, D.M.;, J. et al. Characterization of the inflammatory response to severe COVID-19 illness. Am. J. Respir. Crit. Care Med. 2020; (202),812–821. [CrossRef]
7. Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. 2021;Radiology 299(1):E177–E186
8. Pan F, Ye T, Sun P, Gui S, Liang B, Li L et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019; (COVID-19). Radiology 295(3):715–72
9. Shiva RA,Stephanie LH, Nikhil AH, 1,2, Kevin KC, Anju S, Jacob FC, et al. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. 2021; J. Clin. Med. 2021; (10), 2452.
10. Deng, L.; Khan, A.; Zhou, W.; Dai, Y.; Md, E.; Chen, R.; Cheng, G. Follow-up study of clinical and chest CT scans in confirmed COVID-19 patients.Radiol. Infect Dis.Sep;7(3):106-113.
11. Das, K.M.; Lee, E.Y.; Singh, R.; Enani, M.A.; Al Dossari, K.; Van Gorkom, K.; Larsson, S.G.; Langer, R.D. Follow-up chestradiographic findings in patients with MERS-CoV after recovery. Indian J. Radiol. Imaging 2017;(27), 342. [CrossRef] [PubMed]
12. Ali RMM, Ghonimy MBI. Post-COVID-19 pneumonia lung fibrosis: a worrisome sequelae in surviving patients. Egypt J Radiol Nucl Med. 2021; 52(1):101
13. Beigel, J.H.; Tomashek, K.M.; Dodd, L.E.; Mehta, A.K.; Zingman, B.S.; Kalil, A.C.; Hohmann, E.; Chu, H.Y.; Luetkemeyer, A.; Kline,S.; et al. Remdesivir for the treatment of Covid-19—Final report. N. Engl. J. Med. 2020; (383), 1813–1826. [CrossRef] [PubMed]
14. Shah AS , Wong AW , Hague CJ , et al. A prospective study of 12-week respiratory outcomes in COVID-19-related hospitalisations. Thorax 2021;(76):402–4.
15. Zhao Y-M , Shang Y-M , Song W-B , et al . Follow-Up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine 2020;(25):100463.
16. Hui DS, Wong KT, Ko FW, et al.The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest 2005;(128):2247–61.
17. Sola I , Almazán F, Zúñiga S, and Enjuanes L. Continuous and discontinuous RNA synthesis in coronaviruses. Annual review of virology. 2015, (2): 265-288.
How to Cite
IVANOVSKA, Beti Zafirova; STOJKOVIKJ, Jagoda. MASSIVE PULMONARY FIBROSIS AFTER SEVERE BILATERAL PNEUMONIA AS POST COVID-19 COMPLICATION. Journal of Morphological Sciences, [S.l.], v. 4, n. 3, p. 144-148, dec. 2021. ISSN 2545-4706. Available at: <>. Date accessed: 21 jan. 2022.