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.