Case presentation:
A 48-year-old gentleman came back from a travel abroad and was tested
positive for COVID-19 while screening him as part of post travel
protocol. despite being asymptomatic, COVID-19 PCR from Nasopharyngeal
swab was positive with a CT value 15 on 15th November 2020. His past
medical history was remarkable for Diabetes mellitus type II, on
metformin and gliclazide, and Sickle Cell Disease on hydroxyurea 500 mg
BID. He had no previous surgeries. He has a history of recurrent pain
crisis; most of them were managed in the Emergency department. His last
blood transfusion in 2011. He has hypersplenism and avascular necrosis
of the left shoulder, on conservative therapy. His last painful crisis
was on 9the October 2020, for which he was managed with IV fluids, pain
management, and discharged later in the same day. After testing positive
for coronavirus, Labs (as shown in table 1) and Chest Xray (as shown in
table 2) were ordered.
He was started on treatment; Favipiravir + Amoxicillin/Clavulanic acid
for COVID-19 infection pneumonia, plus enoxaparin for deep vein
thrombosis (DVT) prophylaxis. On day 4, he started to have intolerable
back pain. Labs were repeated (Table 1) and the patient was transferred
to ICU to manage his pain crisis. Repeated Chest X ray showed Interval
progression of bilateral basal atelectasis and faint infiltrates more on
the right side, which worsened later. Amoxicillin/Clavulanic acid was
changed to Piperacillin/Tazobactam, hemoglobin was low (5.4) with
hemolysis picture, Exchange transfusion was done for the patient, with 6
PRBCs. Dexamethasone was also added. The patient became stable after the
transfusion and pain management. Another Chest x ray done 2 days later
showed incomplete resolution of the widespread consolidation distributed
over both lung fields when compared to a chest x-ray done 2 days ago his
condition was improving. A repeated HbS was 22. 3 days later, he was
discharged, with instructions about safety netting and home isolation,
with resumption of his home medications. Throughout his stay in the
Hospital, he did not need high oxygen flow nor intubation (the highest
oxygen requirement was 1 – 2 L nasal cannula for one day).