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.