Case 2
A 62 years old Iranian housewife presented with productive coughs, dyspnea, and weakness. The patient has a history of DM-2 which is being controlled by metformin, gliclazide, pregabalin, and atorvastatin. a week before the visit ago, the patient was hospitalized for three days with fever and chills, and myalgia. After discharge, coughs and dyspnea were exacerbated. The patient has a history of contact with a symptomatic person. She received two doses of the COVID-19 vaccine. Vital signs were as follows: temperature of 36.9°C, heart rate of 102/min, blood pressure of 110/80 mmHg, a respiratory rate 24 of breaths per minute and SPO2 of 90%.
In physical examination, the conjunctiva was pale and the crackle was auscultated in both lungs. Based on the history and symptoms of the patient, PCR tests for COVID-19 and influenza were taken which were positive simultaneously. In spiral chest CT-Scan, there were bilateral diffuse tubular bronchiectasis, subpleural involvement, and consolidation more suggestive of influenza. However, the presence of opacity as well as ground-glass opacity and subpleural lines were more suggestive of COVID-19 infection. Oseltamivir 75mg PO every 12 hours and remdesivir 200mg STAT and 100mg daily through IV-line together with cefepime 1g every 8 hours and vancomycin 1g every 12 hours both via IV-line started for the patient.