Case History
A 57-year-old male with shortness of breath, fever, dry cough, and chest pain was admitted to our center. Six weeks back, he was diagnosed with COVID-19 on RT-PCR and was being managed at another center with oxygen via nasal cannula at 2L/minute. However, due to the increased severity of his symptoms, he was referred to our center.
His medical history was notable for type 2 diabetes mellitus and hypertension for six years. He had been non-compliant with his medication for one year. He had a myocardial infarction two years back, for which coronary artery grafting was performed. He also had features of hypertensive heart disease with mild concentric left ventricular hypertrophy and grade 2 left ventricular diastolic dysfunction.
The physical examination at admission revealed an ill-looking patient with bilateral crepitations. Blood investigations showed a fasting blood glucose level of 165.3 mg/dl and a post-prandial glucose level of 226.6 mg/dl. He was managed with IV antibiotics, heparin, insulin on a sliding scale, and other supplemental medications. He developed an acute kidney injury with hyperkalemia during the course, which resolved after three days.
On the 10th day of admission, he had worsening shortness of breath and an inability to maintain saturation at an oxygen flow rate of 2Lit/min. Therefore, a chest X-ray (Figure: 1a) was performed, which showed a right-sided pneumothorax associated with bilateral lung opacities. However, a chest X-ray performed six days after admission showed no findings suggesting pneumothorax (Figure 1b).