Treatment, outcome and follow-up
When it comes to the treatment provided to our patient, we divided it
into 2 phases. First, is the phase of stabilization in which the patient
was resuscitated using saline infusion that resulted in raising her BP
to 110/70 as well as an IV bolus of hydrocortisone 200 mg every 6 hours.
Second, is the maintenance phase in which the patient was commenced on
hydroxychloroquine, meropenem and pantoprazole. We also provided
adequate analgesia in addition to zinc and vitamin C supplements.
24 hours after admission, her fever improved, and the hemoptysis as well
as the epigastric pain subsided. Nonetheless, she was still drowsy with
a GCS of 11 and SaO2 of 90% off oxygen. Her vitals were as follows: PR=
110, BP= 100/60, RR= 28. We continued the same management plan but
replacing hydrocortisone with methylprednisolone 500 mg, Clexane 6000 IU
S.C every 12 hours with quinine, doxycycline and also adding
N-acetylcysteine to the regimen. We also added vitamin D and Iron
tablets.
On the third day of admission, calcium carbonate tabs 500 mg every 8
hours were also added to aid with managing her hypocalcemia (Serum Ca =
7.1 mg/dL, Procalcitonin = 1.5). She also received a packed red cell for
a few days during her admission resulting in her Hb level being raised
from 6.9 to 10.6 gm/dL. Over the next few days and by the
8th day of admission, her fever subsided and she
gradually regained her normal mental status and level of consciousness.
Her vitals were also stabilized and they were as follows: PR= 75,
BP=120/70, RR=14 and SaO2 of 98% off oxygen. Her nasal swab for COVID
came back negative and she was then discharged on oral cefditoren,
hydroxychloroquine, prednisone, iron tablets, omeprazole as well as
calcium carbonate. She has been followed up a month later without
complications.