Case
A 35-year-old pregnant woman, 34 weeks gestation, was admitted to a
tertiary hospital after 3 hours of clear vaginal fluid discharge. Labor
occurred spontaneously on that day, and a healthy female baby was
delivered with no evidence of infection (SARS-CoV-2 negative upon throat
swab). This was the mother’s second pregnancy and delivery. On the
second day after vaginal delivery, the patient presented with persistent
low fever and dry cough. Laboratory investigations showed
white blood cell count (WBC) 7.1×\(10^{9}\)/L (reference range 3.5-9.5),
neutrophil ratio (N%) 84.7% (reference range 40-75), lymphocyte count
(L#) 0.69×\(10^{9}\)/L (reference range 1.1-3.2), and C-reactive
protein (CRP) 73.63 mg/L (reference range 0.0-0.4). Throat swabs from
the patient tested positive for SARS-CoV-2 by real-time RT-PCR assays,
and the chest CT scan showed multiple infiltrations of different sizes
in both lungs and a small amount of fluid on both sides of the chest.
Considering these findings, the patient was diagnosed with SARS-CoV-2
and isolated. She had no other history of comorbidities, and was treated
with i.v. antibiotics and hormones, and was administered oxygen through
a nasal catheter (Figure 1). The patient experienced dyspnea and
cyanosis on the following day. Considering her critical condition, she
was transferred to the intensive care unit (ICU) for further treatment.
After transferring to the ICU, she quickly developed severe acute
respiratory distress syndrome (ARDS), and her symptoms did not improve
after she was given a non-invasive ventilator. The CT scan showed a
density shadow and a large-scale ground-glass opacity in both lungs,
which had progressed in severity compared with the scan on Day 2
post-delivery. She required tracheal intubation on the 14th day of
hospitalization. Gram-positive and gram-negative bacteria (Acinetobacter
baumannii, Klebsiella pneumoniae) were positively cultured in her
sputum. Antibiotics were administered according to the results of a drug
sensitivity test. Empirical antifungal treatment was also given.
Antiviral, nutritional and symptomatic treatments were also performed
simultaneously. After 11 days of ICU treatment, the patient’s condition
significantly improved. Tracheal intubation was removed and replaced
with non-invasive ventilator. The patient was changed to high-flow
humidified oxygen several days later, and she was transferred to the
general ward for treatment. Her symptoms and primary treatment strategy
are illustrated as shown in Figure 1.