Case of the day

Covid X-ray rapid change

35yrs old male with no chronic illness presented to emergency with flu like illness + normal investigations including the normal CXR except high CRP (50) descharged on Rx as outpatient + swab which returned as (-ve) today Today visited ER with sever SOB, hypoxia, temp 40, Investigation: CRP 200, CXR (attached) DIAGNOSIS AND MANAGEMENT PLAN?

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Repeat CXR shows b/l Lz pulmonary infiltration predominantly peripheral S/O viral or atypical pneumonitis Patient is febrile, dyspneic , hypoxic with viral pneumonitis all are strongly indicative of COVID 19. Repeat CXR Do Ferritin ,LDH- if high methyl prednisolon inj D-dimer - high inj LMWH ABG- hypoxic - O2- BiPAP IL-6- high - cytokines storm - inj tocilizumab 8 mg/kg Do consider Anti viral- Remdesivir or fevipiravir

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1st cxray looks normal as patient presented in early phase of infection so that throat swab test is negative. 2nd Cxray shows changes of organising pneumonia. Adv CECT thorax Resend RT PCR for SARS cov2. NIV oxygen support. Vitals stability Consider methylprednisolone Adv IL 6 level Echo CD PCT To differentiate between sepsis, cardiogenic Pulmonary edema And covid pneumonia. Further may consider Remdesivir, sarolimumab or favipiravir etc. Plz update the case sir.

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Second X ray chest is showing peripheral ground glass appearance highly suggestive of COVID 19 His first COViD 19 test was probably false negative He is having breathlessness and Hypoxia indicating severe disease Adv Admission Repeat test for COVID 19 Maintain oxygen saturation with non rebreathing mask or non invasive ventilation It appears that he is in a phase of cytokine Strom, he may benefit from methylprednisolone His blood sugar need to be monitored and controlled with insulin infusion Higher Antibiotics Prone ventilation Investigation to check liver and renal function test, electrolyte

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1st xray is almost normal 2nd xray chest shows typical covid19 presentation of GGOs in peripheral chest suggestive of pneumonitis and pulmonary oedema Cardiomegaly noted Take ecg to r/o myocarditis and pericardial effusion Rx protocols of covid19 to be followed Antivirals Lopinavir /Remdesivir/or recently added Fepinavir Tab azithromycin Diuretics Anticoagulants Steroids

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

* GGO .. ? COVID-19 .. NEED'S.. REPEAT.. RT.. PCR COVID-19.. MANAGEMENT AS PER.. ICMR PROTOCOLS.. FOR.. COVID-19..

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