Abstract Introduction Interstitial lung disease (ILD) is an uncommon but severe complication of COVID-19, contributing to long term pulmonary dysfunction. Pulmonary osseous metaplasia, characterized by ectopic bone formation in lung parenchyma is an exceptionally rare finding in ILD. We present a case of post COVID-19 ILD with osseous metaplasia, highlighting clinical presentation, diagnostic findings, management, and outcomes. Case Description A 34 year old female presented with exertional dyspnea and persistent hypoxia limiting activities of daily living. She reported a severe COVID-19 infection four years prior requiring hospitalization after which, she eventually was discharge home on oxygen. Four years post the infection, she presented with worsening shortness of breath. High resolution CT (HRCT) revealed bilateral diffuse ground glass opacities with linear scarring suggestive of fibrosis. A lung biopsy was done and revealed non-neoplastic lung parenchyma with foci of osseous metaplasia, airway remodeling and atelectasis consistent with dendriform pulmonary ossification (DPO). Discussion Pulmonary ossification particularly DPO, is characterized by branching bone spicules along alveolar septa, often associated with chronic pulmonary conditions like ILD or fibrosis. In this case, the patient’s severe COVID-19 history likely triggered a fibrotic process with osseous metaplasia as a rare sequela. Clinically DPO may be asymptomatic or cause restrictive ventilatory impairment as seen in this patient’s exertional dyspnea and hypoxia. Management is focused on supportive care including supplemental oxygen and pulmonary rehabilitation. In severe case lung transplantation may be required. Conclusion This case underscores pulmonary osseous metaplasia as a rare complication of COVID-19 related ILD, emphasizing the importance of HRCT and lung biopsy for diagnosis in atypical presentations. As post COVID-19 pulmonary sequelae become increasingly recognized, clinicians should consider rare entities like osseous metaplasia in patients with persistent respiratory symptoms. Further research is needed to elucidate the mechanism linking COVID-19 to such rare pulmonary complications and to optimize therapeutic strategies. This abstract is funded by: None
Fakorede et al. (Fri,) studied this question.