Case presentation:
A 22-year-old male presented to the hospital with history of fever, sore
throat, mild nonproductive cough, generalized body ache, chest pain,
fatigue, and decreased appetite for three days. Positive sick contact
history with an a positive COVID-19 case, no recent travel. His past
medical history was remarkable for non-transfusion dependent Sickle cell
disease taking Hydroxyurea 500 mg daily, no previous surgeries, previous
recurrent painful crisis most of them did not require hospital admission
and presented as generalized pain, pain in the right arm and left hip
which appeared to be avascular necrosis, last painful crisis was 7
months before as lower limb pain relieved with tramadol . Primary
investigations including Laboratory tests, Nasopharyngeal swab for
COVID-19 PCR, chest Xray were performed and the result were as
following: Table.1
To this point the patient differential diagnosis was: Acute chest
syndrome triggered with COVDI-19 infection or viral pneumonitis. He
admitted to the intensive care unit (ICU) after considering him as high
risk for COVID-19 complication. The decision was made to do red blood
cells exchange early in the course of the infection to avoid possible
deterioration in his case and the need of intubation. Upon admission to
the ICU his vital were as following: Temperature 36.4, Heart rate
69/min, Respiratory rate 20/ min, Blood pressure 117/59 mmHg, maintain
oxygen saturation of 96% on room air, he didn’t require any oxygen
supplementation in ICU. He was on the following medications: Lopinavir/
Ritonavir (Kaletra) 200/50 mg for two days then stopped and cefuroxime
1.5 g daily for 7 days, Hydroxyurea 500 mg daily, enoxaparin 40 mg SC as
thrombosis prophylaxis though he had Thrombocytopenia which is relative
contraindication as well he is high risk of thromboembolic in SCD.
Plasma exchange with 6 units PRBCs was done on the second day of
hospital admission without any complications. He stayed in the ICU for 4
days for observation then transferred to the ward, during ICU admission
no deterioration was happened, in the ward repeated Chest X-ray was
normal. After 6 days in the ward without any deterioration in his
clinical course with resolving of respiratory symptoms the patient was
discharged to a quarantine facility.