2. Case presentation
On February 18, 2020, a 47-year-old with acute respiratory syndrome, high fever (39.6 C) and severe shortness of breath was admitted to ICU at Ghaem Hopital in Karaj, Iran. Regarding strong suspicion of the Covid-19 infection complete laboratory tests and Spiral chest computed tomography (CT) scan without contrast were performed for the patient. CT scan findings were consisted of bilateral ground glass opacities predominantly in lower zones, multiple atelectasis bilaterally in same regions, and elevation of right hemidiaphragm. No evidence of pericardial effusion, pleural fluid collection/thickening were reported. Imaging findings were characteristic of pneumonia attributed to SARS-CoV-2.
The patient had a history of epilepsy, gout (uric acid 9.0 mg/dl) and diabetes. Initial laboratory findings were described as follows: low white blood cells (WBC, 3400 / microliter), high blood sugar (BS, 179 mg/dl), impaired liver function tests; (SGOT/AST, 65 U/L and SGPT/ALT, 41 U/L) and low potassium (K, 3.2 mEq/L) (Table 1). In the first day of admission, patient received 200 mg of Hydroxychloroquine tablets twice daily (bd), 200 mg of Lopinavir/ Ritonavir tablets twice daily (bd), and Oseltamivir tablets 75 mg daily. On the second day, patient body temperature was reported 38.8 C and the Wright test was found negative. Moreover, liver enzymes SGOT/AST and SGPT/ALT were elevated to 85 and 56 U/L, respectively. Due patient’s history and an episode of seizure during hospitalization, Levetiracetam 500 mg intravenous (IV) daily and Levofloxacin tablets 750 mg daily were added to his treatment. On 3rd post-admission day, he had 38⁰C fever. Sputum culture was performed which came back negative 48 hours later. Naproxen tablet 500 mg daily was added to his medication. On 7th post-admission day, patient expired due to reduced oxygen pressure and asystole myocardial infarction.