Post COVID‐19 organizing pneumonia treated with mycophenolate mofetil

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Abstract
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.