31-year-old male patient went to the emergency room at Hospital Sancta Maggiore, with fever for three days, associated with runny nose, dry cough and general malaise. On physical examination, obesity BMI 36. He was in regular general condition, with a respiratory rate of 22ipm. A test was collected for COVID-19 and a viral panel. Prescribed symptomatic medicine, oseltamivir 75mg every 12 hours for 5 days, according to local guidelines and sent for observation at home.
He returns 4 days later, with clinical worsening and dyspnea on minimal effort and persistent fever. On admission, RR 24ipm, fever up to 38.5°C, 93% saturation in ambient air. Viral panel with negative test for COVID-19. He underwent low-dose chest computed tomography, the most significant finding was ground-glass pulmonary opacities, in multifocal distribution, predominantly bilateral, peripheral / subpleural and posterior. The extent of pulmonary involvement due to such opacities is about 25% to 50% of the lung volume. Laboratory tests documented haemoglobin 13 g/dL and increased C-reactive protein (CRP) (6 mg/dL).
The only comorbidity was obesity.
During the next 3 days, suddenly, saturation drop and required oxygen supplementation increase to 6 l/min, with the need for artificial ventilation. The patient’s pO2 was 58 mmHg. CRP raised 64mg/dL.
He was then referred to the intensive care unit, undergoing mechanical ventilation. Upon admission to the ICU, SAPS score was 74.57%. Collected again, nasal test for COVID 19 with positive result.
Then, hydroxychloroquine 200mg was introduced every 12 hours and azithromycin 500mg, once a day, according to the institutional protocol.
mechanical ventilation requiring pronation, for 20 hours every day. And need for norepinephrine to maintain systolic blood pressure.
After 4 days of the new therapeutic regimen, the mechanical ventilation parameters began to improve. The result of PCR tests of bronchoalveolar fluid was negative. The patient recovered from SARS-CoV-2 infection and was discharged after 3 weeks hospitalized.
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