Case
A 45-year-old woman reported to the outpatient department (OPD) on 21st
October 2020, complaining of fever, body-ache, headache, cough, and loss
of taste sensation since 5days. She started treatment prescribed by her
family doctor, but the breathlessness continued to exacerbate. Her elder
son of 32 years of age was suffering from COVID-19. On examination her
pulse was elevated, measuring 110 per minute, blood pressure (BP) 160/80
mmHg, respiratory rate 38 per minute, bilateral crepts were heard over
both the lungs. She denied having respiratory distress despite suffering
from severe dyspnoea. Her temperature was 99.4 degrees Fahrenheit and
oxygen saturation was 76% at ambient air. Investigation showed
haemoglobin at 11.3 gms/dl, total leucocyte count at 6080/ microL
(N=4000-10000), lymphocyte count at 970.8/ microL (N=1500-4000) ,
lymphocytes 12.2/microL (N=40-600), c-reactive protein 63mg/L (N=0-6),
serum ferritin as 86.87ng/ml (N=4.63-204), D-Dimer quantification
1837.39 ng/ml (N= <500), HbA1c 5.7%, serum B-12 as 270
ng/ml(N=197-771), vitamin D 15.7ng/ml (N=30-100), TSH 7.15 mIU/L (N=
<4.5). A High-Resolution Computed Tomography of the thorax
revealed 75% (23/25 score) involvement of both lungs (figure A1). She
was administered nasal oxygen at 4 litres per minute on an OPD basis and
her spO2 raised to 84% within one hour, but relatives and the patient
denied indoor hospitalization. She was advised regular treatment at home
for which they agreed. Treatment given was oral favipiravir 1800 mg 12
hourly on the first day and then 400 mg twice a day for one week. ,
ivermectin 12mg twice a day for five days, doxycycline 100 mg twice a
day for five days, aspirin 150 mg once a day after food, metformin 500
mg once a day, dexamethasone 1mg/kg body weight and subsequent tapering
doses in next two weeks, low molecular weight heparin 60 mg
subcutaneously twice a day for seven days. levothyroxine 25microgram on
an empty stomach. Her elder son was given practical training on how to
inject heparin subcutaneously from a prefilled syringe and she was
subsequently isolated in a separate room. Her nasal swab was positive
for SARS-CoV2 –RNA virus. She reported on 23rd October with no
complaints except for mild weakness; her SpO2 was 91% at ambient air
and 88% at the end of six minutes brisk walk. Respiratory rate was 20
per minute. On 27th October, her SpO2 was 99% at rest and was 98%
after a six minutes brisk walk. She reported to hospital on 7th November
with no complaints, SpO2 at rest was 95%with ambient air. Her HRCT
showed on 28th November she felt almost normal; her vitals too were
stable with BP of 110/70 mm hg and respiratory rate 16 per minute with
no crypts in chest SpO2 was 100%. Lastly seen on 9thDecember 2020 with no complaints with SpO2 at100%. Her HCRT done on
9thth December 2020 showed patchy areas intermixed
with thickened interstitial (figure A2).