Case presentation
On July 12, 2020, a 56-year-old man with fever, severe shortness of
breath, cough, and A+ blood group was admitted to
M-ICU at the Ghaem Hospital in Karaj, Iran. He was a pediatrician. A
polymerase chain reaction (PCR) test had been performed before he was
admitted. The PCR findings indicated that the patient was positive in
terms of the presence of SARS-COV-2 at the 24.5 cycle threshold (CT)
value. The patient had a history of high blood pressure and had consumed
the Valsartan tablet 80 mg. Generally, his medication regimen had
included Hydroxychloroquine sulfate, Lopinavir/Ritonavir, Remdesivir,
ReciGen (interferon beta-1a), Naproxen, Dexamethasone, Convalescent
plasma, and Albumin during the period of hospitalization. On the first
day of admission, primary laboratory findings revealed the elevated
level of white blood cells (WBCs, 20900/microliter) with a high count of
neutrophil (91% of WBCs), impaired liver function; (SGPT or ALT, 127
U/L), acute inflammation; (ESR, 30 mm/hr, not shown in Table 1),
negative D-Dimer, and increased fibrinogen (403 mg/dL, not shown in
Table 1). On the 2nd post-admission day, lactate
dehydrogenase (LDH, 477 U/L, not shown in Table 1) test was performed.
Also, a drastic decrease was seen in WBCs count. The enzyme-linked
immunosorbent assay results (ELISA) indicated that both SARS-COV2 IgM
and SARS-COV2 IgG were negative. Renal function was normal (Table 1). On
the next day, the level of total bilirubin was upper than the reference
range. Furthermore, the coagulation system was normal. On this day, the
patient received fresh frozen plasma (FFP). On the
5th post-admission day, the patient’s partial pressure
of oxygen (PO2) and oxygen saturation
(SO2) were lower than normal, and his pulmonary capacity
had reduced. One day later, the result of the hepatitis B surface
antigen (HBsAg) test was reported as non-reactive or negative.
Explicitly, the level of PO2 reached under 40 mmHg.
Meanwhile, renal function was disrupted. A portable chest X-ray (CXR)
revealed that the image size of the heart and mediastinum was normal.
Moreover, the ground-glass opacity (GGO) was seen in peripheral areas of
both lung sides, especially the basal zone. There were no manifestations
in the bony thorax. On the 7th post-admission day and
the next day, the patient received Morphine Sulfate 10 mg/ml solution by
injection each day. Concerning the result of the CXR, the diffused GGO
in hemithorax was proved, and pleural effusion. Finally, the patient
passed away due to respiratory failure, impaired liver function;
(SGPT/ALT, 2500 U/L, SGOT/AST, 4200 U/L), and renal dysfunction. The GGO
was apparent in peripheral areas of both lung sides, and lateral sinuses
were closed. Drastically, the patient’s WBCs count had increased on this
day (Table 1).