Sex: F
Vaccine: COVID19
Symptoms: Physical examination, Pneumonia, Pulmonary fibrosis
Clinical narrative: received a two dose mRNA vaccine, but still contracted COVID-19 resulting in severe pulmonary fibrosis with superimposed bacterial and fungal pneumonia; received a two dose mRNA vaccine, but still contracted COVID-19 resulting in severe pulmonary fibrosis with superimposed bacterial and fungal pneumonia; received a two dose mRNA vaccine, but still contracted COVID-19 resulting in severe pulmonary fibrosis with superimposed bacterial and fungal pneumonia; received a two dose mRNA vaccine, but still contracted COVID-19 resulting in severe pulmonary fibrosis with superimposed bacterial and fungal pneumonia; This is a literature report.  A 74-year-old female patient received COVID-19 Vaccine - Manufacturer Unknown, as dose 1, single (Batch/Lot number: unknown) and as dose 2, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "coronary artery disease" (unspecified if ongoing); "hypertension" (unspecified if ongoing); "hyperlipidemia" (unspecified if ongoing); "dry cough" (unspecified if ongoing); "worsening shortness of breath" (unspecified if ongoing), notes: for the past five days. The patient's concomitant medications were not reported. The following information was reported: DRUG INEFFECTIVE (hospitalization, medically significant, life threatening), COVID-19 PNEUMONIA (hospitalization, medically significant, life threatening), PULMONARY FIBROSIS (hospitalization, medically significant, life threatening), PNEUMONIA (hospitalization, medically significant, life threatening), outcome "unknown" and all described as "received a two dose mRNA vaccine, but still contracted COVID-19 resulting in severe pulmonary fibrosis with superimposed bacterial and fungal pneumonia". The patient underwent the following laboratory tests and procedures: Antibody test: Negative; Negative; Negative; Negative; Blood beta-D-glucan: Positive; Bronchoscopy: deferred in view of worsening lung function.; Chest X-ray: new airspace opacities in the right upper lobe,, notes: vascular congestion, and pulmonary interstitial edema; Computerised tomogram: showed organizing pneumonitis, notes: secondary to COVID-19 with features of fibrosis with a small loculated effusion in the upper lobe, and no evidence of pulmonary embolism; Fraction of inspired oxygen: 100 %; Clinical laboratory: unremarkable; Oxygen saturation: 92 %, notes: on room air; more than 91; Physical examination: coarse crackles in bilateral lung fields. Therapeutic measures were taken as a result of covid-19 pneumonia, pulmonary fibrosis, pneumonia which included anidulafungin (ANIDULAFUNGIN); trimethoprim, sulfamethoxazole (TRIMETHOPRIM, SULFAMETHOXAZOLE), steroids.  Clinical course: A 74-year-old female with a past medical history of coronary artery disease, hypertension, and hyperlipidemia presented to our hospital with dry cough and worsening shortness of breath for the past five days. The patient was admitted two weeks ago for COVID-19 pneumonia and was treated with a course of Remdesivir and Dexamethasone. On arrival, she was afebrile, tachypneic, and saturating 92% on room air. Clinical laboratory results were unremarkable. Physical examination revealed coarse crackles in bilateral lung fields. Chest X-ray revealed new airspace opacities in the right upper lobe, vascular congestion, and pulmonary interstitial edema. Computed tomography angiography of the chest showed organizing pneumonitis secondary to COVID-19 with features of fibrosis with a small loculated effusion in the upper lobe, and no evidence of pulmonary embolism (Figure 1). The patient was started on high-dose intravenous steroids and broad-spectrum antibiotics for possible superimposed bacterial pneumonia. She rapidly deteriorated over the first 48 hours of hospitalization, requiring higher amounts of supplemental oxygen. On further investigation, serum beta-D-glucan was positive, but antibodies for Aspergillosis, Histoplasmosis, Coccidiomycosis, and Blastomyces were negative. Pneumocystis pneumonia was highly suspected given the patient's clinical course; however, bronchoscopy was deferred in view of worsening lung function. Despite empiric treatment with Trimethoprim/Sulfamethoxazole and Anidulafungin, the patient continued to decline. She was transferred to the ICU and was started on Bilevel Positive Airway Pressure (BiPAP) ventilation. Unfortunately, the patient has a guarded prognosis as she is unable to maintain oxygen saturation >91% on BiPAP with 100 % FiO2.  Follow-up attempts completed. No further information is expected.; Sender's Comments: As there is limited information in the case provided, the causal association between the events Drug Ineffective and Covid 19 pneumonia, pulmonary fibrosis, pneumonia, and the suspect drug cannot be excluded. The case will be reassessed once new information is available.