COVID-19: case 47

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Silvia Lucarini, Chiara Moroni, Antonella Masserelli, Edoardo Cavigli, Lina Bartolini, Alessandra Bindi, Silvia Pradella AOU Careggi, Firenze, Direttore Dr. Vittorio Miele.

61-years-old male patient admitted to the ED for severe dyspnea, confusion on March 3.  Bedfast after a recent upper respiratory infection. Medical history: DM type 2, HTA. Non-smoker.

Blood test: WBC 11.2; C-PR 301 (normal values < 5); LDH 738 (normal values 135-225); Fibrinogen 798 (normal values 200-400); INR 1.4. ABG: PaO2 82; PCO2 32.

A CTA was performed for suspected pulmonary embolism:

Multiple aree di ground-glass estese diffusamente in entrambi i polmoni con inizali aspetti consolidativi nelle regioni basali ove si evidenzia risparmio subpleurico; coesiste moderata riduzione volumetrica di entrambi i polmoni.

Multiple and diffuse ground-glass opacities involving both lungs, associated with consolidations at the bases, those sparing the cortex. Lungs volume is also reduced.

The patient was promptly intubated and a treatment with Lopinavir-Ritonavir and Cloroquine was also started.

Chest film after intubation (March 3):

Chest film on March 6:

comparing to the previous CRX, an improvement of the pulmonary involvement is seen.

On March 12, a chest radiography was required due an increase of the procalcitonin levels (1.96, normal values <0.5):

A new-onset consolidation in the left base is noted, finding suspected for bacterial superimposed infection.

Antibiotics are then introduced along with redemsivir.