Difficult case of COVID-19 in a young patient

Introduction: COVID-19 is an infectious disease caused by SARS-Cov2. Most people infected with the new Coronavirus develop mild to moderate forms of the disease. Elderly people with cardiovascular, respiratory, diabetes or neoplasia are more likely to develop severe forms. The virus is transmitted mainly by coughing or sneezing. The typical manifestation of the disease is fever, dry cough, dyspnea, odynophagia, diarrhoea, headache, anosmia.

Case presentation: A 45-year-old patient, non-smoker, with no known history, presents to the ER accusing, fe-ver, dry cough, diarrhoea, dyspnea, asthenia, myalgia for which he underwent symptomatic treatment. Ba-sed on the symptoms, epidemiological data, clinical, lab tests and imaging examination, the suspicion of COVID-19 is raised, later confirmed by nasopharyn-geal exudate RT-PCR. Physical Exam: fever (38.3 °C), dry cough, dyspnoea, RR= 30rpm, SpO2= 93% witho-ut O2 (90% at minimum effort), HR= 105 bpm, BP= 130/90mmHg. Paraclinical: EKG: sinus rhythm, hori-zontal axis, HR= 100bpm, no active ischemia, QTc= 320ms. Chest X-ray: Multiple diffuse opacities on both lung fields with peripheral distribution and tendency to confluence. Biological: nonspecific inflammatory syndrome (VSH, C-Reactive Protein, fibrinogen), mild hypochromic microcytic anemia with sequestration of iron in deposits, neutropenia, lymphopenia, hepa-tocytolysis syndrome, procalcitonin within normal limits, DDimers= 1385.36 ng/mL ABG: respiratory compensated metabolic acidosis.

Results: The patient is hospitalized with the diagnosis of Bronchopneumonia with SARS-Cov2, oxygen de-pendent acute respiratory syndrome, hepatocytolysis syndrome. Treatment is established according to the protocol with Lopinavir / Ritonavir 2-0-2, Azi-thromycin 250mg 2-0-0 on the first day, subsequently 1-0-0 for 7 days, broad-spectrum antibiotic, antipyre-tic, analgesic, hepato-trophic and anticoagulant with Fraxiparin 0.7mL X 2 / day. The clinical and paraclini-cal status of the patient worsens (intense dyspnea, dry cough, SpO2= 91% on O2 mask; C-reactive protein and liver enzymes increasing; decreasing neutrophils and lymphocytes). Chest CT examination reveals ground-glass and crazy paving condensed fibre-nodular lesion pattern. The transfer to the Intensive Care ward is de-cided and corticotherapy is combined with the previ-ous regimen (hydrocortisone hemisuccinate 50mgX2 day) with a slight improvement in symptoms. Sub-sequently, it is decided to transfuse 3 isogroupe plas-ma units, isoRh from cured donors of COVID-19-wi-thout incidences. The results are favourable (no fever, SpO2 = 95% in atmospheric air, BP= 125/75mmHg, HR= 85bpm) until discharge (2 negative RT-PCR CO-VID-19 samples). The patient remains in isolation at home for another 14 days and follows anticoagulant treatment with Apixaban 2.5mg X 2 / day, 40 days. At the end of treatment it is recommended to perform an Angiogram and repeat lab tests.

Particularity: The case presented is important conside-ring the fulminant evolution of a young patient without comorbidities. Although the disease follows a non-spe-cific pattern (inflammatory syndrome, neutropenia, lymphopenia, negative procalcitonin, increased DDi-mers) we can assess the disease based on their follow-up, along with the clinical presentation and imaging assessment of lung lesions. In addition to corticosteroid therapy and plasma transfusion from cured donors was used with spectacular results.



ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)