Clodoveo Ferri, Marco de Pinto, Giuseppe Murdaca, Giacomo De Luca, Davide Mohammad Reza Beigi, Virginia Caira, Roberta Foti, Andrea Cito, Caterina Naclerio, Jessica Maria Elisa Luppino, Amelia Spinella, Martina Orlandi, Veronica Batani, Federica Lumetti, Francesco Prampolini, Giuseppe Varcasia, Rosario Foti, Valeria Riccieri, Florenzo Iannone, Alessandro Antonelli, Dilia Giuggioli, COVID‐19 and Autoimmune Systemic Diseases Italian Study Group
The objective of this study was to assess the impact of severe COVID-19 pneumonia on the course of interstitial lung disease (ILD) in autoimmune systemic diseases (ASD). We conducted a multicentre case series of 27 ASD patients (20 systemic sclerosis, 4 rheumatoid arthritis, 1 interstitial pneumonia with autoimmune features, 1 dermatomyositis, 1 eosinophilic granulomatosis with polyangiitis) hospitalised for severe COVID-19. Clinical data, pulmonary function tests and HRCT before and after infection were analysed. Four patients died during acute COVID-19. Among the 23 survivors, 10 developed new symptomatic ILD and 13 showed worsening of pre-existing ILD. Six exhibited significant HRCT progression, including NSIP-to-UIP transition; one developed lung adenocarcinoma. Despite treatment, five more patients died during follow-up from progressive ILD. Overall mortality approached one-third, with systemic sclerosis most affected. Severe COVID-19 may trigger or accelerate ASD-related ILD. The observed NSIP-to-UIP shift highlights a multistep process potentially driven by SARS-CoV-2, underscoring the need for close ILD monitoring in ASD patients.