Case 4
This is the case of a 77-year-old man with hypertension, emphysema, and
old tuberculosis, who is an ex-smoker and who presented with fever and
sore throat. Levofloxacin and ciclesonide were administered on day 8 for
bilateral pneumonia with respiratory failure. He was diagnosed with
COVID-19 on day 10. He needed IMV due to a rapid progressive respiratory
failure on day 11. P/F was 170, which was classified as moderate ARDS at
that time. Although favipiravir has been initiated, low-dose steroid
(hydrocortisone 250mg/day), IVIG, sivelestat, and PPT were administered
after intubation. The respiratory status improved temporarily, but P/F
worsened with evident SOP. SPT (methylprednisolone 1000mg for three
days) was initiated from day 14. After this therapy, P/F, LDH, and CT
findings were improved (Figure 1. ). PSL 30mg (0.5mg/kg/day) was
started after the pulse therapy, and the dose was gradually tapered. He
was successfully extubated on day 30, negative conversion of RT-PCR was
confirmed on day 24, and finally he was discharged without oxygen demand
on day 30. PSL was finished on day 33.