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Lack of efficacy: case report A 47-year-old man exhibited a lack of efficacy during treatment with norepinephrine and vasopressin for hypotension [dosages not stated]. The man, who had a complex medical history including kidney transplantation, was admitted to a hospital in the USA due to various symptoms during Coronavirus disease 2019 (Covid-19) pandemic. He had been receiving various medications. On presentation, he was noted to have neutropenia and hypotension. Based on investigations, he was diagnosed with Covid-19. Hypotension was initially managed with sodium chloride [Normal saline]. By day 4 of hospitalisation, his condition continued to deteriorate. Then, he received filgastrim for neutropenia. A rapid recovery of neutropenia was noted. Later, his shortness of breath progressed with decreased oxygen saturation. He was then shifted to the ICU. He received various medications. On day 5, he underwent intubation and mechanical ventilation for worsening oxygen saturation and tachypnoea. His BP decreased to 75/46mm Hg (hypotension), and treatment with IV norepinephrine and vasopressin was started. However, the hypotension persisted. He remained intubated on mechanical ventilation during the next 4 days. He also developed atrial fibrillation and amiodarone was administered. His hypotension worsened progressively and he required higher dose of vasopressors. On day 9 of hospitalisation, he died [immediate cause of death not stated]. Taha M, et al. Clinical deterioration during neutropenia recovery after G-CSF therapy in patient with COVID-19. Respiratory Medicine Case Reports 31: 1-4, Jan 2020. 803514746 Available from: URL: http://doi.org/10.1016/j.rmcr.2020.101231

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Reactions 14 Nov 2020 No. 1830