COVID-19 Pneumonia and hy...

A man in his early 70s was admitted to the hospital with leg weakness, fever, and a dry cough. He had a medical history of type 2 diabetes and hypertension. His clinical frailty score was 2–3 on the Rockwood scale. 

Clinical Findings

Hepatomegaly and generalised weakness were positive results on clinical review. On room temperature, the peripheral oxygen saturation (SpO2) was 97%, and the temperature was 38.4 degrees Celsius. On admission, the chest X-ray was unremarkable. SARS-CoV-2 RNA was detected in a nasopharyngeal swab, indicating COVID-19 infection.

The patient's fever persisted over the next week, necessitating a higher flow of supplemental oxygen to keep his SpO2 levels stable. In the event of a coexisting bacterial infection, he was started on empirical antibiotics. The patient had been informed of a treatment escalation plan and had refused admission to intensive care for ventilatory support. 

With a SpO2 of 80% on 19 L/min oxygen, the patient became steadily dyspnoeic and hypoxic, rapidly worsening with respiratory distress. In keeping with serious pneumonitis, a repeat chest X-ray revealed new bilateral air space opacification.