Case presentation:
A 48-year-old gentleman came back from a travel abroad and was tested positive for COVID-19 while screening him as part of post travel protocol. despite being asymptomatic, COVID-19 PCR from Nasopharyngeal swab was positive with a CT value 15 on 15th November 2020. His past medical history was remarkable for Diabetes mellitus type II, on metformin and gliclazide, and Sickle Cell Disease on hydroxyurea 500 mg BID. He had no previous surgeries. He has a history of recurrent pain crisis; most of them were managed in the Emergency department. His last blood transfusion in 2011. He has hypersplenism and avascular necrosis of the left shoulder, on conservative therapy. His last painful crisis was on 9the October 2020, for which he was managed with IV fluids, pain management, and discharged later in the same day. After testing positive for coronavirus, Labs (as shown in table 1) and Chest Xray (as shown in table 2) were ordered.
He was started on treatment; Favipiravir + Amoxicillin/Clavulanic acid for COVID-19 infection pneumonia, plus enoxaparin for deep vein thrombosis (DVT) prophylaxis. On day 4, he started to have intolerable back pain. Labs were repeated (Table 1) and the patient was transferred to ICU to manage his pain crisis. Repeated Chest X ray showed Interval progression of bilateral basal atelectasis and faint infiltrates more on the right side, which worsened later. Amoxicillin/Clavulanic acid was changed to Piperacillin/Tazobactam, hemoglobin was low (5.4) with hemolysis picture, Exchange transfusion was done for the patient, with 6 PRBCs. Dexamethasone was also added. The patient became stable after the transfusion and pain management. Another Chest x ray done 2 days later showed incomplete resolution of the widespread consolidation distributed over both lung fields when compared to a chest x-ray done 2 days ago his condition was improving. A repeated HbS was 22. 3 days later, he was discharged, with instructions about safety netting and home isolation, with resumption of his home medications. Throughout his stay in the Hospital, he did not need high oxygen flow nor intubation (the highest oxygen requirement was 1 – 2 L nasal cannula for one day).