Case Report of a Critically Ill Patient with COVID-19 in Early Outbreak

Chenglu Zhang¹, Haohao Cao², Donghui Huang¹ and Hongfeng Jiang^3,

¹Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

²Department of Critical Medicine, Wuhan Fourth Hospital & Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

³Geriatrics Department, Wuhan Fourth Hospital & Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Cite this paper

Chenglu Zhang, Haohao Cao, Donghui Huang and Hongfeng Jiang. Case Report of a Critically Ill Patient with COVID-19 in Early Outbreak. American Journal of Medical Case Reports. 2022; 10(4):101-109. doi: 10.12691/AJMCR-10-4-5

Abstract

Introduction: Corona Virus Disease 2019 (COVID-19) has spread rapidly throughout the world. Many people died of this disease. We reported a case of critical illness with COVID-19 pneumonia that occurred in the early stage of viral spread in China and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s symptoms throughout the course. Patient concerns: This article describes the whole diagnosis and treatment process of a critically ill patient in a case report. Diagnosis: The patient was a physician and presented to a fever clinic with a history of treating a suspected patient without special protection the day before. After 5 days, a nucleic acid test for COVID-19 was positive. Then, the patient was transferred to the intensive care unit (ICU) immediately because of severe dyspnea. He was diagnosed with COVID-19 based on a history of exposure, severe acute respiratory syndrome, positive COVID-19 test and chest computed tomography (CT). Interventions: Various therapies were used in this critically ill patient, including anti-infection drugs, hormones, immunoglobulins, herbal medicine, noninvasive ventilation, and special plasma. Outcomes: The patient recovered completely and was discharged after one month of hospitalization. COVID-19 was tested negative and a chest CT showed marked improvement prior to discharge after 4 weeks admission. Conclusion: This study highlights the complexity of treatment and recurrent positivity of the critically ill COVID-19 pneumonia patient and aims to provide useful reference and information for our knowledge of the clinical spectrum of disease.

Keywords

COVID-19, coronavirus, pneumonia, diagnosis, treatment

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-33.
[2]	Huang C, Wang Y, Li X,et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506.
[3]	World Health Organization. Novel coronavirus — China. 2020 (https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/. opens in new tab).
[4]	Sun P, Qie S, Liu Z, et al. Clinical characteristics of 50 466 hospitalized patients with 2019-nCoV infection. J Med Virol. 2020 Feb 28.
[5]	Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 Feb 24. pii: S2213-2600(20)30079-5.
[6]	Zumla A, Hui DS, Azhar EI, et al. Reducing mortality from 2019-nCoV: host-directed therapies should be an option. Lancet. 2020; 395(10224): e35-e36.
[7]	Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Jan 29.
[8]	Young BE, Ong SWX, Kalimuddin S, et al.Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020 Mar 3.
[9]	Xu X, Yu C, Qu J, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020 Feb 28.
[10]	Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States.N Engl J Med. 2020; 382(10): 929-936.
[11]	Silverstein WK, Stroud L, Cleghorn GE, et al. First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. Lancet. 2020 Feb 29;395(10225):734.
[12]	Bastola A, Sah R, Rodriguez-Morales AJ, et al.The first 2019 novel coronavirus case in Nepal. Lancet Infect Dis. 2020; 20(3): 279-280.
[13]	National Health Commission of the People’s Republic of China. Laboratory guidelines for novel coronavirus pneumonia. (http://www.nhc.gov.cn/wjw/index_gzbd.shtml).
[14]	National Institutes of Health. GenBank overview (https://www.ncbi.nlm.nih.gov/genbank/. opens in new tab).
[15]	GISAID (Global Initiative on Sharing All Influenza Data) home page (https://www.gisaid.org/. opens in new tab).
[16]	National Health Commission of the People’s Republic of China. Diagnosis and treatment of novel coronavirus infection pneumonia.(http://www.nhc.gov.cn/wjw/index_gzbd.shtml).
[17]	Tang B, Bragazzi NL, Li Q, et al. An updated estimation of the risk of transmission of the novel coronavirus (2019-nCov). Infect Dis Model. 2020;5:248-255.
[18]	Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020; 55(3): 105924.
[19]	Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Feb 19.
[20]	Li LQ, Huang T, Wang YQ, et al. 2019 novel coronavirus patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020 Mar 12.
[21]	Xiong Y, Sun D, Liu Y, et al. Clinical and High-Resolution CT Features of the COVID-19 Infection: Comparison of the Initial and Follow-up Changes.Invest Radiol. 2020 Mar 3.
[22]	Zhou L, Liu K, Liu HG. Cause analysis and treatment strategies of “recurrence” with novel coronavirus pneumonia (covid-19) patients after discharge from hospital. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43(0): E028.
[23]	Zhou W, Liu Y, Tian D, et al. Potential benefits of precise corticosteroids therapy for severe 2019-nCoV pneumonia.Signal Transduct Target Ther. 2020; 5: 18.
[24]	Li H, Wang YM, Xu JY, Cao B.Potential antiviral therapeutics for 2019 Novel Coronavirus. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 5; 43(0): E002.
[25]	Hama R, Bennett CL. The mechanisms of sudden-onset type adverse reactions to oseltamivir. Acta Neurol Scand. 2017 Feb; 135(2): 148-160.
[26]	Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci Trends. 2020 Mar 16; 14(1): 69-71.
[27]	Wang M. , Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020; 30(3): 269-271.
[28]	MacIntyre CR, Chughtai AA, Barnes M, et al. The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. BMC Infect Dis. 2018; 18(1): 637.
[29]	Han Q, Lin Q, Jin S, You L.Recent insights into 2019-nCoV: a brief but comprehensive review. J Infect. 2020 Feb 25. pii: S0163-4453(20)30087-6.
[30]	Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020; 395(10225): 683-684.
[31]	Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin forthe treatment of severe acute respiratory infections of viral etiology: a systematicreview and exploratory meta-analysis. J Infect Dis. 2015; 211(1): 80-90.
[32]	Xiaoming, Hou Jifeng. Current situation of convalescent plasma treating acute viral infectious diseases and the Novel coronavirus pneumonia. Yang China Journal of Biologics, 2020-02-22.
[33]	National Health Commission of the People’s Republic of China. convalescent plasma therapy schedule for novel coronavirus. (http://www.nhc.gov.cn/yzygj/s7658/202003/61d608a7e8bf49fca418a6074c2bf5a2.shtml).
[34]	Liu Xi, Wang Rongshuai, Qu guoqing, et al. Systematic anatomy report of novel coronavirus pneumonia death corpse. Journal of Forensic Medicine. 2020; 36(1): 1-3.
[35]	Liu Y, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020 Mar; 63(3): 364-374.
[36]	Ulldemolins M, Roberts JA, Rello J, et al. The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. Clin Pharmacokinet. 2011 Feb; 50(2): 99-110.