Case 1
This is the case of a 61-year-old man with hypertension and who is an ex-smoker, who presented with fever, upper respiratory tract symptoms, and myalgia. He was diagnosed with COVID-19 on day 11. Lopinavir/ritonavir (LPV/r), ciclesonide, azithromycin (AZM), and ampicillin/sulbactam (ABPC/SBT) were initiated after diagnosis. He needed invasive mechanical ventilation (IMV) due to a rapid progressive respiratory failure on day 13. The ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) was 136, which was classified as moderate ARDS at that time. Low-dose steroid (hydrocortisone 250mg/day), intravenous immunoglobulin (IVIG), and sivelestat were started after intubation. The respiratory status improved temporarily, but P/F worsened again due to evident SOP. SPT (methylprednisolone 1000mg for three days) was started from day 19. After this therapy, P/F, LDH, and CT findings were improved (Figure 1. , Figure 2. ). Prednisolone (PSL) 40mg (0.5mg/kg/day) was started after the pulse therapy, and the dose was gradually tapered. He was successful extubated on day 23, negative conversion of RT-PCR was confirmed on day 43, and finally he was discharged without oxygen demand on day 48. PSL was finished on day 49.