COVID PNEUMONITIS WITH CYTOKINE STORM IN YOUNG OBESE MALE

30 years male weighing around 100kg, Presenting with acute onset breathlessness & severe dry cough for last 2-3 days. On admission, Temp 98 Pulse 100/min BP 110/78 Spo2 84% on air Important Blood investigations.. Altered N/L ratio CRP significantly elevated SGPT raised FERRITIN >2000 D Dimer 1100 Ecg Sinus tachycardia RT PCR for SARS COV-2 report is awaited. Chest X ray images are as followed.. Patient is on Oxygen with NRBM @ 15L/Min Awake proning & IV PIPTAZ, IV MPS, INJ LMWX, HCQS & supportive treatment. Discuss further management plan. Regards.

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Bil diffuse parenchymal fluffy infiltration seen. Findings sugg of ARDS. Cilinical history sugg of covid pneumonia. Needs to differentiate between cardiac and Infective etiology. Adv HRCT thorax. NT probnp Sr lactate level PCT level ECHO CD IL 6 level, in view of Asso sepsis and cytokine storm. Continue same line of treatment. Wait for covid 19 RT PCR. Sos Consider tocilizumab , remdesivir, as Clinicoradiologicaly mod to severe stage.
TOCILIZUMAB n REMDESIVIR both need to be started sir but problem is availability.
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Extensive GGOs bilateral all over chest All reports ferritin D-dimer are raised Undoubtedly a c/o covid19 With hypoxia You are following protocols very well Just look for cardiac developments and add accordingly
Thanx dr Sandeep Ghodekar
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Ards bilateral pneumonia blood report spo2 84 low looks sarscov2 confirm RT PCR hrct
It's typically a case of moderately severity viral pneumonia/? Covid positive Ya follow treatment tat u given continue Ya piptaz BD , medrol 60 BD, enox 0.6BD, vit. C OD, zincovit OD, glutone 250 OD, cap. D-rise OD, T. Azithral 500 OD,o2 support , chest physiotherapy Advised to do: LFT, RFT, TSH, FBS, PPBS, CT chest to see the severity. If the score more than 75℅ I. e severe pneumonia then add Tocilixumab Repeat Ddimer, LDH, CRP.
Provisional dx-covid 19 ARDS involving lunģs. Continue same tt.in icu. Pt may be taken on ventilator if needed.
In first impression it looks like tuberculosis But covid 19 test results will decide pts future treatment
? Covid adv thyroid function tests and cardiac status ? Cardiomyopathy also
Pneumonitis with pleural effusion .? Koch's. ? viral.
? ARDS ? COVID 19 ? Pneumonitis
ARDS may be COVID19 POSITIVE
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