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):