Scar Wars: The Viral Menace

Pulmonary fibrosis (PF) is a formidable consequence of severe respiratory infections, marked by excessive extracellular matrix deposition and irreversible lung architectural damage. Once considered a rare and obscure sequela, PF is now increasingly recognized in the wake of viral infections, particularly among survivors of viral-induced acute respiratory distress syndrome (ARDS). The COVID-19 pandemic has cast a spotlight on this phenomenon, revealing a stark reality: many patients who endure severe viral pneumonia do not fully recover, instead developing persistent fibrotic changes that compromise lung function. This review unpacks the clinical evidence and underlying mechanisms linking viral infections—COVID-19, influenza, and other respiratory viruses—to the onset of pulmonary fibrosis. By delving into cellular injury, immune dysregulation, and aberrant repair mechanisms, we aim to illuminate the pathways that transform an acute viral insult into a chronic, fibrotic disease.