Case 2
This is the case of a 43-year-old woman with bronchial asthma who presented with fever, cough, malaise, arthralgia, and dysgeusia. She was diagnosed with COVID-19 on day 6. LPV/r was initiated when she had pneumonia with oxygen demand on day 8. Hydroxychloroquine (HCQ), AZM, and ABPC/SBT were added on day 9 since her respiratory status worsened. She needed IMV due to a rapid progressive respiratory failure on day 10. P/F was 149, which was classified as moderate ARDS at that time. Ciclesonide, low-dose steroid (hydrocortisone 250mg/day), IVIG, and sivelestat were started after intubation. The respiratory status improved temporarily, but P/F worsened with evident SOP. Initially, prone position therapy (PPT) was started from day 14, and SPT (methylprednisolone 1000mg for three days) was initiated for SOP from day 15. After this therapy, P/F, LDH, and CT findings were improved (Figure 1. ). After the pulse therapy, PSL 30mg (0.5mg/kg/day) was started, and the dose was gradually tapered. She was successfully extubated on day 21, negative conversion of RT-PCR was confirmed on day 27, and finally she was discharged without oxygen demand on day 31. PSL was finished on day 38.