Case presentation (Disease diagnosis and treatment):
Md. Rabiul Awal is a patriotic Biotechnologist who started his unpaid
work without fear of death in the COVID-19 detection laboratory in the
Shahjalal University of Science and Technology, Sylhet, Bangladesh on
the behalf of DGHS (Directorate General of Health Services) of
Bangladesh Government from the very beginning of the COVID-19 pandemic.
During a high surge of the Delta variant of Coronavirus, when he was
working as a scientific officer in Japan Medical Center located in Dhaka
city for COVID-19 detection, he got infected with COVID-19 with the
symptoms of fever (99°F) and headache on 22th April, 2021 and medication
was started with rivaroxaban, Paracetamol, Zinc Sulfate Monohydrate,
Colecalciferol (Vitamin D3), Vitamin C, Montelukast Sodium, Fexofenadine
Hydrochloride, Ivermectin and Doxycycline Hydrochloride. Doses of the
medicines were maintained as prescribed by the consultant physician. At
the same time, the patient started to suffer from body ache, weakness,
cough and remittent fever (101°F-105°F). On 26 April 2021, fever
decreased to 99°F but dyspnea started. The SpO2 of the patient fell down
and that was nearly 85% in the pulse Oximeter after 1:00 am of 27 April
2021.
At 11.15 am of 27 April 2021, the patient was admitted in the Japan East
West Medical College Hospital in COVID-19 Cabin Block. On examination,
his SpO2 was 90% with 15 L/min O2 by
NRBM, BP was 140/70 mmHg, Pulse 121 b/min, RR 30 br/min, Temperature
99.5 °F. After admission the patient’s condition gradually deteriorated
therefore at 12.30 pm on 27 April 2021 patient was shifted to ICU and
patient was put into HFNC immediately. Despite giving 80 L/min
O2 through HFNC, the patient could not maintain
SpO2. Then NIV was given with 100%
FiO2, but the patient’s SpO2 was not
maintained, and gradually the patient became drowsy and disoriented. ABG
could not be performed due to failure of locating arterial lines. So
mechanical ventilation starts at 11.30 pm. Here all relevant
investigation was done and patient was diagnosed as a case of Covid-19
pneumonia (critical) with ARDS (corrected) with Type 1 respiratory
failure (corrected), with acute heart failure with Myocarditis,
pericarditis and pleural effusion, with AKI (corrected) with
Hyponatremia, and with Churg-Strauss syndrome (CSS). Conservative
treatment was given with mechanical ventilation. Patient’s
SpO2 and FiO2 improved gradually after
taking two-unit of Fresh frozen plasma and bevacizumab injection. After
5 days of mechanical ventilation, extubation was done on May 2, 2021 and
the patient was put into HFNC. Thereafter, the patient’s condition
improved rapidly and a HRCT was done which showed 68% involvement. His
2nd RT-PCR was done on May 5, 2021 and which was COVID-19 negative. As
his condition was stable and improving, he was shifted to Medicine IPD
on May 8, 2021. The patient was discharged from the hospital with advice
on May 13, 2021, when his health was better and fit for discharge. After
the COVID-19 infection, the patient suffered about 6 months from the
post COVID-19 symptoms with diabetes, psychotic disorder, panic,
anxiety, weakness, extrapyramidal side effects and erectile dysfunction.
Tables of laboratory findings is given below:
A few test that was done on 27 April 2021 (Hospital Day 0/
Sickness Day 6):