Covid-19 (case n.1)
Patient with chronical congestive heart failure, hypertension, diabetes, anxiety and depression. Her husband died of Covid-19 (positive RT-PCR test after death). The patient has also seen subjected to home swab test which confirmed the positivity for SARS-CoV-2. 4/3: appearance of feverish symptoms with cough and worsening dyspnea. Oxygen saturation values of 95%. Therefore transport was organized to our hospital. Lab tests documented relative lymphopenia, hypochromic microcytic anemia, with an increase in interleukin-6 (45,82 pg/ml), myoglobin (260 mg/dl), CK-MB (6,03 ng/ml), CPK (369 U/L) and troponin (0,018 ng/ml).
Pre-admission chest CT documents "ground glass" parenchymal areas located in the peripheral site in both lungs, larger on the left. In particular, in the the left upper lobe antero-lateral segment (where "crazy paving" pattern is associated), lingula, left lower lobe lateral segment and in the posterior segments of both lungs (subpleural sites). Other similar, more limited thickenings was identifiable in the left upper lobe apico-posterior segment, in the right upper lobe apical segment and in the right retroesophageal recess (at the lower lung lobe). The findings was compatible with medium-grade viral interstitial pneumonia. Collaterally, there was two nodular formations in the middle lobe lateral segment (7 mm), so we raccomanded follow-up at 3-6 months, in accordance with the Fleishner Society guidelines. There is also moderate pericardial effusion. Subsequently, the patient manifests worsening respiratory conditions, also for her basic heart disease. Therefore she was treated with high flow oxygen therapy, which stabilizes the clinical picture, thus avoiding the intubation. Antiviral and antibiotic therapy (levofloxacin) is also administered. 4/18: pulmonary ultrasound documented visceral pleura irregularities (pleural thickenings), particularly evident in the lingula and in the right lower lobe. The patient, significantly improved from the clinical point of view and negative on the double swab, was discharged on 4/29.