Pulmonary Cavitation as a Late and Self-Limited Complication of COVID-19 Pneumonia: A Case Report.

Pulmonary cavitation is an uncommon late complication of coronavirus disease (COVID-19), and its underlying mechanisms remain incompletely understood. We report a case of a 37-year-old previously healthy man who developed bilateral cavitary lung lesions in the first weeks following hospitalization for severe COVID-19 pneumonia requiring noninvasive ventilation, systemic corticosteroids, and empiric broad-spectrum antibiotics. A computed tomography pulmonary angiogram performed during the index admission showed typical COVID-19 changes without cavitation. Twenty-one days after discharge, he was readmitted with pleuritic chest pain and was found to have a new large, thick-walled cavitary lesion with an air-fluid level in the left lower lobe, followed one week later by a second gas-filled cavity in the right upper lobe. Despite these radiological findings, he remained clinically stable, with no fever, respiratory compromise, or leukocytosis. Extensive evaluation, including repeat computed tomography (CT) pulmonary angiography, blood and sputum cultures, autoimmune screening, bronchoscopy, bronchoalveolar lavage (with bacterial, mycobacterial, and fungal studies), and galactomannan testing, was entirely negative. In view of the reassuring clinical and laboratory profile, antimicrobial therapy was stopped, and the patient was managed conservatively with close follow-up. Serial imaging over five months demonstrated complete resolution of both cavities without further intervention. This case illustrates a self-limited form of post-COVID pulmonary cavitation in a young adult with a negative infectious workup and emphasizes the importance of integrating clinical stability, inflammatory markers, and thorough diagnostic assessment to distinguish noninfectious post-COVID cavitation from necrotizing infection and to avoid unnecessary prolonged antimicrobial treatment.