Question normal

Case presentation:
A Male his 40s. He is a mining worker, mine is at 4300 meters above of sea level. He developed the following symptoms on 03/18, 4 days after arriving, dry cough, malaise, odynophagia. He was evaluated on site, he improved with non-steroidal anti-inflammatory drugs. On 03/19 appear fever 38.5 °C, shortness of breath, cough with phlegm. He didn’t work that day. On 03/20 he returned to work, but symptoms do not improve despite NSAIDs. He was transferred to Huaraz city, 3100 meters above sea level.
On arrival he looks dyspneic but felt better, BP 90/60, RR 22 P 90 SPO2 91 % on room air. The Lake Louise Score is 7. On auscultation bilateral crackles. Rest not contributory
Pertinent laboratory values
6,1x103/uL Leucocytes, 17,9 g/dl Hemoglobin, 1,89x103/ uL Lymphocytes, Bastones: 0,06x103/uL, CRP 53,9mg/dl, DHL: 141 U/L. Arterial blood gases FiO2 21%, pH 7,43, PO2 68,6 mmHg PCO2 29,1 mmHg, HCO3 19,5 mEq/L, BE -2,7mEq/L, Na 139,2mEq/L, K 3,74 mEq/L, Cl 111,3 mEq/L, D-dimer 0,20ug UEF/ml. RT-PCR COVID-19 done and sent to Lima for processing.
Pertinent imaging
CT scan shows multiple peripheral ground glass opacities on admission, with control on 3rd day and 5th day.
Treatment and Outcomes
Patient started Ceftriaxone, Azithromycin, Salbutamol inhaler, Ipatropium Bromide inhaler. Oxygen supplement FiO2 28 %
Positive RT-PCR COVID-19 was confirmed after 5 days of arrival
Good clinical evolution, on 4th day no oxygen needed. He will be discharged on 03/04 from the hospital to Trujillo city.
Lesson learned
This case illustrates the difficulty to difference between HAPE and COVID-19. We decided not to use steroids because of mayor risk of severe COVID-19 disease.