Case report
The patient was 28-year old women with no history of any significant
co-morbidities. She had a history of contact with COVID-19 cases, but no
history of travel outside Dhaka or other country for last six months.
Her relative was diagnosed as COVID-19 on 24th June, 2021 with whom she
lives. On June 26, 2021, the case felt a mild cough followed by blood in
cough one time. As her family history was positive, she went for testing
for RT-PCR for SARS-CoV-2 and became positive on 28thJune, 2021 and was in isolation at home and in addition, the dengue RDT,
Ag NS1 (ICT) was negative. Her symptoms included dry cough, sore throat,
fever (100°F) and shivering at night. She had hemoptysis for two times
on June 28, 2021, which consisted of scanty amount of blood. On the next
day she had fever (highest body temperature 102°F), with dry cough
constantly, sore throat followed by fatigue. She monitored her vital
signs regularly and her oxygen saturation was 98-99%. Routine blood
tests such as, complete blood count, serum creatinine, D-dimer, serum
ferritin done and test results were normal (Table 1). Her chest x-ray
also revealed no abnormalities. The patient started medications from
June 29, 2021 which included Paracetamol 500mg 1tab 8hourly,
Azithromycin 500mg once at night, Montelukast 10mg once at night,
Desloratadine 10 mg once in the morning and Multivitamin once in the
morning.
On 30th June 2021, physical examination indicated normal vital signs. On
auscultation of the lungs, a vesicular breath sound was heard, along
with bilateral basal coarse crepitation. There was sign of red rash
without itchiness on both upper limbs of the body. Then again on
6th July, investigations were conducted; laboratory
reports showed hemoglobin 11.5L g/dL, lymphocyte count 23.2%,
neutrophil 72.3%, total leucocyte count 5.13L x 10^ 9/L, red cell
count 4.40 x 10^ 12/L, mean cell hemoglobin 26.1 pg, platelet count
175 x 10^ 9/L and dengue IgM was positive, CRP was 0.34. On
6th July mild respiratory distress occurred with dry
cough and she was given Salmeterol Xinafoate and Fluticasone Propionate
(25/125) two times a day and Deflazacort 6mg started 2-tab 8 hourly.
Thoracic computed tomography (CT) done on 6th July,
2021 revealed subtle ground glass and consolidative opacities were noted
in different segments of both lungs, predominantly in a peripheral
location with basal distribution, nearly 30% of lung involvement was
present. Also sub centimetric mediastinal lymph nodes was also present
(Figure 1). These findings were reported in accordance with alveolar
hemorrhage.
On 8th July 2021, the patient was in moderate
respiratory distress. Her temperature was 100 °F, blood pressure
120/70 mmHg, pulse rate 96 bpm (regular) and oxygen saturation on
pulse-oximetry 92-95 % without oxygen. Basal crepitation was found on
lung auscultation. She was admitted to the Green life medical college
hospital, Dhaka for respiratory distress. Then she was immediately
started on stat dose of Remdesivir 200mg IV, Hydrocortisone 100mg 8
hourly, nebulization with Ipratropium Bromide plus Salbutamol 8 hourly,
Montelukast 10mg at night, Paracetamol 500mg as required, Moxifloxacin
400mg once at night. She did not require any oxygen during
hospitalization. On 9th July 2021, the patient was
stable with ongoing treatment and her blood and urine culture, both
reports revealed no bacterial growth and her oxygen saturation
95%-98%. On the 10th July 2021, she was discharged from hospital in a
relatively stable condition, with the above-mentioned drugs and advice
of respiratory exercise. Hemoptysis was her first symptom on June
26th, and she experienced twice the next day, in the
morning and at night. Actually, this patient was treated at home
initially from June 29 to July 7, 2021 and she had self -medication at
home. Also due to the red rash, a dengue test was again performed on
July 6, 2021 and the results were positive for dengue IgM. Then on the
8th July 2021, she was admitted to the hospital, and on the 10th July
2021, she was discharged. On July 15, 2021, she recovered and became
symptom-free. During follow-upon July 29,2021, a chest CT revealed full
clearance of the ground glass opacities, and an RT PCR of a
nasopharyngeal swab for SARS-CoV-2 was negative, indicating that her
clinical condition had improved There was no further occurrence of
hemoptysis after recovery from COVID-19.