Severe progression of idiopathic pulmonary fibrosis post-COVID-19 infection

A 79-year-old woman presented with a week-long history of shortness of breath. She had a background of idiopathic pulmonary fibrosis (IPF) which was stable and had not required any antifibrotic treatment. A month prior to this presentation, she was admitted with COVID-19 pneumonia, with maximal oxygen requirement of 2 L, but was discharged without need for supplemental oxygen. On readmission, she was found to have severe, rapidly progressive pulmonary fibrosis. After all precipitating causes were ruled out, it was felt her recent COVID-19 infection was the exacerbating factor causing progression of pulmonary fibrosis. COVID-19 infection has been hypothesised to cause long term pulmonary fibrosis, but this is the first case highlighting COVID-19 infection as the causative agent exacerbating IPF.