Treatment
The patient underwent a chemotherapy course according to the ”7+3DNR 60
mg/m2” scheme. Besides, for the treatment of COVID-19, he received a
glucocorticosteroid with dexamethasone 8 mg per day, heparin therapy, as
well as NIV in the CPAP mode with FiO2=70%, a change in body position
was carried out on the stomach with ventilation.
Also, the patient had persistent fever, an increase in CRP and
procalcitonin levels, the condition was regarded as febrile neutropenia,
given which ABT (antibiotic therapy) piperacillin-tazobactam 4.5g IV
4p/s was prescribed, against the background of this therapy, the
condition with improvement, in the form of a decrease in body
temperature and CRP over time. At +12D after a course of chemotherapy,
repeated bend of fever, an increase in CRP in dynamics, in connection
with which ABT was replaced by meropenem 1.0 g IV 3p/s. In dynamics,
against the background of the ongoing complex therapy, the patient’s
condition improved, in the form of a decrease in signs of respiratory
failure, a tendency to restore blood counts (Table 2). With the control
PCR COVID-19 at +19D after chemotherapy, no infection was detected,
however, according to the control computed tomography of the chest,
negative dynamics was noted in the form of an increase in infiltration
in the lungs (Figure 2).
According to the results of control puncture at +14D, blastosis remained
at 50%, remission was not achieved. Continuation of chemotherapy is
indicated, to which the patient did not consent.
The patient was discharged from the hospital with no remission of the
underlying disease, requiring continuation of treatment and relief of
signs of coronavirus infection.