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.