Case History
A 57-year-old male with shortness of breath, fever, dry cough, and chest
pain was admitted to our center. Six weeks back, he was diagnosed with
COVID-19 on RT-PCR and was being managed at another center with oxygen
via nasal cannula at 2L/minute. However, due to the increased severity
of his symptoms, he was referred to our center.
His medical history was notable for type 2 diabetes mellitus and
hypertension for six years. He had been non-compliant with his
medication for one year. He had a myocardial infarction two years back,
for which coronary artery grafting was performed. He also had features
of hypertensive heart disease with mild concentric left ventricular
hypertrophy and grade 2 left ventricular diastolic dysfunction.
The physical examination at admission revealed an ill-looking patient
with bilateral crepitations. Blood investigations showed a fasting blood
glucose level of 165.3 mg/dl and a post-prandial glucose level of 226.6
mg/dl. He was managed with IV antibiotics, heparin, insulin on a sliding
scale, and other supplemental medications. He developed an acute kidney
injury with hyperkalemia during the course, which resolved after three
days.
On the 10th day of admission, he had worsening shortness of breath and
an inability to maintain saturation at an oxygen flow rate of 2Lit/min.
Therefore, a chest X-ray (Figure: 1a) was performed, which showed a
right-sided pneumothorax associated with bilateral lung opacities.
However, a chest X-ray performed six days after admission showed no
findings suggesting pneumothorax (Figure 1b).