CASE PRESENTATION
The patient is a 73 years old female with a history of non-ischemic
cardiomyopathy prior to orthotropic heart transplantation in 2007,
percutaneous coronary intervention (PCI) to the left anterior descending
artery (LAD) in 2014, diabetes mellitus, hypertension, obesity, stroke,
gouty arthritis, recurrent urinary tract infection (UTI) on treatment.
The immunosuppression regimen consisted of tacrolimus 1 mg twice daily
on milrinone 200 mg daily infusion at home.
The patient presented on April 2020 to the hospital because she was
having loose, watery stools for one day, vomiting, and oliguria in
addition to shortness of breath not associated with cough, sore throat,
or runny nose. The clinical examination showed temperature 38.4°C, heart
rate of 109, blood pressure of 149/70, respiratory rate 20 and oxygen
saturation 89% bilateral lung crepitation on auscultation, abdomen
soft, no guarding, non-tender grossly normal extremities, no pitting
edema, pale palpebral conjunctiva, anicteric sclera, pale lips, and
nailbeds. COVID-19 (PCR) was done, which came positive, and urine
culture showed E. coli and K pneumonia . Chest X-ray showed
pulmonary congestion, blunted left cost phrenic angle, suggesting mild
pleural effusion/thickening. Notable laboratory values include: Hb 7.8
g/dl (12-15 g/dl), Urea 9.8 mmol/L (2.5 – 7.8 mmol/L), CRP 103.2 mg/L
(0.0- 5.0 mmol), Procalcitonin 0.70 ng/mL (0.15 ng/mL), Troponin 24 ng/L
(3 – 10 ng/L), Pro-BNP 1276 pg/mL .
Hence, she was admitted to the intensive care unit (ICU) as a case of
COVID-19 infection and UTI; she was started on amlodipine 10 mg, aspirin
75 mg once daily, azithromycin 500 mg for 5 days ertapenem 1g infusion
for 5 days, hydroxychloroquine for 5 days, furosemide 20 mg for 5 days,
prednisolone 5mg for 5 days, pantoprazole 40 mg for 5 days, oseltamivir
75 mg twice daily day 2 to day 5. On day 2 She was in distress,
requiring continuous positive airway pressure (CPAP) therapy, then she
was stable on room air alternating with non-invasive ventilation and
never required intubation. Her ICU course of admission was for a total
five days without any complications; she was subsequently improved and
transferred to the medical floor for one-day observation and discharged
the next day.
An echocardiogram was done on 29 April 2020 for follow up it showed a
mild precordial effusion, no right pulmonary hypertension, Normal global
systolic LV function (EF 61 %). There were no significant valvular
abnormalities.