Discussion:
Fever, cough, weakness, vomiting, runny nose, sneezing, headache, body
ache, feeling very unwell and shortness of breath or dyspnea are the
common symptoms of Covid-19 [7, 8]. In case of severe Covid-19,
dyspnea of the patient develop into acute respiratory distress syndrome
with Type 1 respiratory failure and the patient needs to treated
carefully with intensive care unit (ICU) support. Acute respiratory
failure is one the most common cause of death in case of Covid-19
patient [9]. In Bangladesh, 15.53 % of them were severely ill in a
random sample of 103 RT-PCR confirmed case of Covid-19 [10].
In this case study, the patient’s suffering condition can be divided
into three stages. 1st stage (Mild to moderate
condition): where the patient suffered from fever and cough for 5 days
and shortness of breath for 1 day. 2nd Stage (Covid-19 pneumonia Severe
Condition): In this stage, the patient was in coma for 5 days and
suffered from ARDS with Type 1 respiratory failure, acute heart failure
with myocarditis and pericarditis, Churg-Strauss syndrome (CSS), Kidney
disorder with Hyponatremia, Oral ulcer, Conjunctivitis and diabetes. 3rd
stage (Post Covid-19 symptoms): In this stage, he suffered from diabetes
for about two months and psychotic-disorder, erectile dysfunction,
panic, fear, anxiety, and extrapyramidal side effects for about six
months. About all the symptoms of three stages were observed in the
review article of Hassan S et al . and Cascella M et al.[8, 11] without extrapyramidal side effects and erectile
dysfunction. The patient suffered from Covid-19 (mild to moderate
condition) from 22 April 2021 to 26 April 2021; Severe condition from
27April 2021 to 2 May 2021 and later he suffered from Post Covid-19
symptoms for about 6 months.
During admission in Japan East West Medical College Hospital (now SHIP
International Hospital), the patient’s blood sample was tested for
Chikungunya Ab, Dengue Ab, Dengue Ag NS1, HBsAg, HCV-Ab, Syphilis and MP
and those showed negative results. Therefore, it was confirmed that the
patient was suffering from Covid-19 (that was tested on 22 April 2021).
Increased level of white blood cell, neutrophil, lymphocyte, ESR,
D-dimer, CRP (C-reactive protein), Pro-BNP, Serum creatinine,
Interleukin-6, Random blood sugar, Serum Ferritin, LDH (lactate
dehydrogenase), Troponin-I, INR was observed in the severe condition of
the patient and the similar increased level of results were discussed in
Al Noman et al. and Hassan S et al. [10, 11].
Covid-19 pneumonia with acute respiratory distress syndrome with type 1
respiratory failure was confirmed with X-Ray, HRCT (High-resolution
computed tomography) and severe shortness of breath. Acute heart failure
with myocarditis, pericarditis and pleural effusion was detected by
irregular heartbeat, X-ray, HRCT, ECG, and other laboratory tests (such
as- Pro-BNP, D-dimer and Troponin-I). Kidney disorder was investigated
by serum creatinine and serum electrolytes. Diabetes was detected by
Blurred vision, urinating more often and being thirstier and measured by
RBS (random blood sugar) and HbA1c test. Churg-strauss syndrome was
confirmed by clinical symptoms such as- rash, gastrointestinal bleeding,
body pain and loss of strength.