Case 1
This is the case of a 61-year-old man with hypertension and who is an
ex-smoker, who presented with fever, upper respiratory tract symptoms,
and myalgia. He was diagnosed with COVID-19 on day 11.
Lopinavir/ritonavir (LPV/r), ciclesonide, azithromycin (AZM), and
ampicillin/sulbactam (ABPC/SBT) were initiated after diagnosis. He
needed invasive mechanical ventilation (IMV) due to a rapid progressive
respiratory failure on day 13. The ratio of arterial oxygen partial
pressure to fractional inspired oxygen (P/F) was 136, which was
classified as moderate ARDS at that time. Low-dose steroid
(hydrocortisone 250mg/day), intravenous immunoglobulin (IVIG), and
sivelestat were started after intubation. The respiratory status
improved temporarily, but P/F worsened again due to evident SOP. SPT
(methylprednisolone 1000mg for three days) was started from day 19.
After this therapy, P/F, LDH, and CT findings were improved
(Figure 1. , Figure 2. ). Prednisolone (PSL) 40mg
(0.5mg/kg/day) was started after the pulse therapy, and the dose was
gradually tapered. He was successful extubated on day 23, negative
conversion of RT-PCR was confirmed on day 43, and finally he was
discharged without oxygen demand on day 48. PSL was finished on day 49.