Clinical Features of a young Patient with COVID-19 presented with ARDS and severe thrombocytopenia

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.