Case Description

A 65-year-old woman presented to the COVID-19 clinic of the hospital with complaints of fever, cough, myalgia, and dyspnea for five days. The patient underwent real-time PCR (RT-PCR) for SARS-CoV-2 infection test and chest CT scan. The chest CT scan was normal (Figure 1a), but the PCR test for COVID-19 was positive. She was treated at home with naproxen 1000 mg per day and bed rest. Six days later, she returned to the hospital with a dry cough, tachypnea, and dyspnea. On admission, the patient’s respiratory rate was 31breath/min, and SPO2 was 83%, which reached 93% with 5 liters of nasal oxygen. The patient’s blood pressure was 100/70 mm Hg, and her temperature was 37.1C˚. CT scan was performed again, and lung involvement was found multifocal, bilateral ground-glass pattern (GGO) in both lungs’ lower and middle lobes (Figure 1b). The patient was treated with remdesivir 200mg in 0.9% Sodium Chloride 250ml IV infused over 60 minutes on the first day, then 100 mg daily on days 2-5, Enoxaparin 60mg every 12 hours subcutaneous, methylprednisolone 1 mg/kg/day infused in two divided doses in 0.9% Sodium Chloride 250ml, famotidine 40 mg PO every 12 hours, Diphenhydramine Hydrochloride 25 mg orally every 6 hours, paracetamol 500mg every 6 hours PO and Bromhexine orally 8mg three times a day. Despite the treatments, the patient’s respiratory distress worsened with tachypnea and dry cough. The new CT showed significantly increased lung involvement associated with COVID-19 infection. There are widespread GGO’s and crazy paving (figure 1c). Blood oxygen saturation percentage dropped to 76%. On day ninth, Remicade(Infliximab) was infused to the patient at a dose of 4 mg / Kg, after receiving negative results for PPD, Hbs Ag, HCV Ab, HIV Ab tests, and obtaining the consent form. Seventy-two hours after infusion, the general condition improved, shortness of breath disappeared and the SPO2 increased by 89 and 99% with reservation. One week after the infusion, there was no sign of respiratory distress, and the chest CT showed a significant reduction in lung involvement (Figure 1d). Cough and shortness of breath were stopped on the fifth day after infusion. The recovery process continued in the following days, and she was discharged one week after Remicade infusion. One month after receiving the drug, nearly the patient has returned to her pre-Covid infection condition, and chest CT scan showed mild GGOs pattern involvement (Figure 1e). The laboratory findings of the patient are listed in table1.