Clinical Features of a young Patient with COVID-19 presented with ARDS and severe thrombocytopenia
Journal
Medical Research Journal
Date Issued
2022-07-22
Author(s)
Mickovski, Ivana
DOI
10.5603/MRJ.a2022.0032
Abstract
Case report of a 33-year-old male SARS-CoV-2 positive patient admitted to hospital because of hemopty sis, dyspnea, fever, oxygen saturation of 60%, hypoxemia, elevated C-reactive protein (CRP). The patient
was not vaccinated and it was his first infection with the virus. The symptoms started 10 days before with
headache, fever, and cough. Chest radiography on hospital admission detected diffuse interstitial pneu monia in both lungs. Initial CT (Computed Tomography) presented extensive lung involvement with bilateral
wide areas of consolidation with air bronchogram, the non-consolidated area showing patchy ground
glass infiltration. The patient was hospitalized in ICU (Intensive Care Unit), oxygen support was started
immediately with non-invasive ventilation (NIV), CPAP (Continuous Positive Airway Pressure) mode, FiO2
(Fraction of inspired Oxygen) 100%, PEEP (Positive end-expiratory pressure) 8, and the saturation started to
increase. Therapy consisted of parenteral antibiotic, low-molecular weight heparin (LMWH) in prophylactic
doses, pulsed dose of corticosteroid (methylprednisolone), Remdesivir, tocilizumab (Actemra), albumin,
protein-pump inhibitor, antipyretics, fluids, physical therapy. Microbiology results from sputum detected
MRSA (methicillin-resistant Staphylococcus aureus) and therapy with Vancomycin was started according
to recommendations. After three days of vancomycin therapy, the patient manifested profuse epistaxis
and tamponade was necessary. Hemostasis result was normal, but severe thrombocytopenia was noticed
in the blood count. Platelets and plasma were administered and the bleeding stopped. Vancomycin was
replaced with Linezolid. In the next days of follow up, the platelets increased, and the corticosteroid dose
was slowly reduced. During the treatment as the health status of the patient improved, the CPAP therapy
was replaced with routine oxygen support, gradually lowering the oxygen flow until saturation of 94% was
achieved at ambient air. The COVID-19 pandemic is still evolving and the medical fraternity is posed with
a huge challenge. COVID-19 is primary a respiratory viral infection, but the virus can affect many organs
and systems, presenting various signs, symptoms and outcomes.
was not vaccinated and it was his first infection with the virus. The symptoms started 10 days before with
headache, fever, and cough. Chest radiography on hospital admission detected diffuse interstitial pneu monia in both lungs. Initial CT (Computed Tomography) presented extensive lung involvement with bilateral
wide areas of consolidation with air bronchogram, the non-consolidated area showing patchy ground
glass infiltration. The patient was hospitalized in ICU (Intensive Care Unit), oxygen support was started
immediately with non-invasive ventilation (NIV), CPAP (Continuous Positive Airway Pressure) mode, FiO2
(Fraction of inspired Oxygen) 100%, PEEP (Positive end-expiratory pressure) 8, and the saturation started to
increase. Therapy consisted of parenteral antibiotic, low-molecular weight heparin (LMWH) in prophylactic
doses, pulsed dose of corticosteroid (methylprednisolone), Remdesivir, tocilizumab (Actemra), albumin,
protein-pump inhibitor, antipyretics, fluids, physical therapy. Microbiology results from sputum detected
MRSA (methicillin-resistant Staphylococcus aureus) and therapy with Vancomycin was started according
to recommendations. After three days of vancomycin therapy, the patient manifested profuse epistaxis
and tamponade was necessary. Hemostasis result was normal, but severe thrombocytopenia was noticed
in the blood count. Platelets and plasma were administered and the bleeding stopped. Vancomycin was
replaced with Linezolid. In the next days of follow up, the platelets increased, and the corticosteroid dose
was slowly reduced. During the treatment as the health status of the patient improved, the CPAP therapy
was replaced with routine oxygen support, gradually lowering the oxygen flow until saturation of 94% was
achieved at ambient air. The COVID-19 pandemic is still evolving and the medical fraternity is posed with
a huge challenge. COVID-19 is primary a respiratory viral infection, but the virus can affect many organs
and systems, presenting various signs, symptoms and outcomes.
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