Case 2
This is the case of a 43-year-old woman with bronchial asthma who
presented with fever, cough, malaise, arthralgia, and dysgeusia. She was
diagnosed with COVID-19 on day 6. LPV/r was initiated when she had
pneumonia with oxygen demand on day 8. Hydroxychloroquine (HCQ), AZM,
and ABPC/SBT were added on day 9 since her respiratory status worsened.
She needed IMV due to a rapid progressive respiratory failure on day 10.
P/F was 149, which was classified as moderate ARDS at that time.
Ciclesonide, low-dose steroid (hydrocortisone 250mg/day), IVIG, and
sivelestat were started after intubation. The respiratory status
improved temporarily, but P/F worsened with evident SOP. Initially,
prone position therapy (PPT) was started from day 14, and SPT
(methylprednisolone 1000mg for three days) was initiated for SOP from
day 15. After this therapy, P/F, LDH, and CT findings were improved
(Figure 1. ). After the pulse therapy, PSL 30mg (0.5mg/kg/day)
was started, and the dose was gradually tapered. She was successfully
extubated on day 21, negative conversion of RT-PCR was confirmed on day
27, and finally she was discharged without oxygen demand on day 31. PSL
was finished on day 38.