Role of COVID-19 in the Progression of Scleroderma Interstitial Lung Disease and New Onset Pulmonary Hypertension: A Challenging Case Report

This case report describes an 80-year-old woman with systemic sclerosis (SSc), complicated by interstitial lung disease (ILD) and new-onset pulmonary hypertension (PH), likely triggered by an atypical SARS-CoV-2 infection. Diagnosed with SSc in 2016 and previously stable ILD, she experienced clinical deterioration in 2023 with worsening respiratory failure and PH. Despite negative PCR and antigen tests, high anti-SARS-CoV-2 IgG levels and CT findings were consistent with COVID-19-related organising pneumonia. Intravenous glucocorticoids led to partial symptom improvement, although ILD progression continued. The patient died in December 2023 from pneumococcal pneumonia. This case highlights the complex interaction between SSc and COVID-19, where overlapping mechanisms of endothelial injury and fibrosis may exacerbate pre-existing organ damage. It underscores the need for a multidisciplinary approach and timely interventions, including vaccination, early clinical assessment and appropriate immunosuppressive or antiviral treatments, to prevent severe infectious complications and halt disease progression in this high-risk patient population.