Clinical course of COVID-19 in a high-risk patient


Authors: R. Hainer 1;  P. Nytrová 2;  M. Slovák 2;  J. Fiksa 2;  L. Lambert 3;  A. Kyslíková 4;  V. Hainer 5
Authors‘ workplace: IV. interní klinika 1. LF UK a VFN, Praha, Přednosta: prof. MUDr. Radan Brůha, PhD. 1;  Neurologická klinika 1. LF UK a VFN, Praha, Přednosta: prof. MUDr. Evžen Růžička, DrSc., FCMA, FEAN 2;  Radiodiagnostická klinika 1. LF UK a VFN, Praha, Přednostka: doc. MUDr. Andrea Burgetová, PhD., MBA 3;  Kožní oddělení Městské polikliniky Praha (Spálená), Ředitel polikliniky: MUDr. David Doležil, PhD., MBA 4;  Endokrinologický ústav, Praha, Ředitelka: doc. RNDr. Běla Bendlová, CSc. 5
Published in: Prakt. Lék. 2021; 101(3): 174-179
Category: Case Report

Overview

We present a 76-year-old male with a past medical history of thromboembolism and coronary heart disease. He was admitted to the hospital with acute hypoxemic respiratory insufficiency due to bilateral COVID-19 pneumonia. As spontaneous O2 saturation dropped to 60% on the second day of the hospital stay, the patient was transferred to the intensive care unit where an intensive oxygen therapy was initiated (HFNO: High-Flow Nasal Oxygenotherapy and non invasive ventilation via CPAP: Continuous Positive Airway Pressure). His oxygen saturation gradually increased and follow-up showed improvement in symptoms. After 17 days of in-patient treatment, he was discharged to homecare. Main factors affecting the outcome of ARDS (Acute Respiratory Distress Syndrome) are considered. Besides the intensive oxygen therapy, an early administration of low molecular heparin, remdesivir and dexamethasone most probably contributed to reversing the initial serious finding in this patient. Clinical improvement was accompanied by improved laboratory tests (CRP, procalcitonin, d-dimer, creatinine, hs-troponin, lymphocyte count). Finally, we discuss a potential association of coronavirus infection with herpetiform exanthema, which appeared before the patient was discharged from the hospital.

Keywords:

COVID-19 – high-risk patient – hypoxemic respiratory insufficiency – intensive oxygen therapy – low molecular heparin – dexamethasone – remdesivir


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