Organizing pneumonia (OP) promptly responds to
corticosteroids. However, a minority of patients demonstrate
corticosteroid resistance or relapse on
corticosteroid tapering. We describe post
COVID-19 OP patients with clinically inadequate response to
corticosteroids but that improved after the addition of
Mycophenolate Mofetil (MMF). Case 1: A gentleman was diagnosed with post
COVID-19 OP but had suboptimal clinico-physiologic-radiologic response and
steroid toxicity during outpatient reviews. MMF was initiated resulting in marked clinical response and quick weaning from
corticosteroids. Case 2: A gentleman with post
COVID-19 OP relapsed during tapering of
steroids.
Clarithromycin and MMF were added to his regimen, which improved his clinico-physiologic parameters and allowed
corticosteroid tapering. Unfortunately, he developed MMF-related
colitis needing
therapy cessation. Currently, no studies have reported on MMF utilization in difficult post
COVID-19 OP patients. Nevertheless, we believe, similar as in non-COVID OPs, MMF or other
immunomodulators, potentially have a role in treating difficult or
steroid-resistant OPs.