Candesartan cilexetil
- PDF / 171,798 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 33 Downloads / 138 Views
1 S
COVID-19 pneumonia: case report An 84-year-old man developed COVID-19 pneumonia during treatment candesartan cilexetil for hypertension. The man presented to a clinic in the China due to a 15-day history of fever, chest discomfort, cough and fatigue. He had been receiving oral candesartan cilexetil [candesartan] and nifedipine for hypertension with effective control [dosage not stated]. He had undergone surgery for disc herniation and was a nonsmoker. On presentation, he received empiric antibiotic therapy with moxifloxacin. After 4 days of the treatment, his fever resolved, but chest discomfort and cough worsened. His two oropharyngeal swabs were collected at >24h intervals and was found to be positive for COVID-19 infection by a reverse-transcriptase PCR assay. He was diagnosed with confirmed COVID-19 pneumonia, and shifted to other hospital in the China [duration of treatment to reaction onset not stated]. On admission, his physical examination was unremarkable except for rough respiratory sounds. Laboratory tests revealed increased leukocyte count with 3.8% lymphocytes and 91% neutrophils and elevated CRP. Occult blood and RT-PCR of stool specimens were negative for COVID-19. His liver function test, renal function test, electrolytes, myocardial troponin-I, blood gas analysis, total cholesterol and glucose were normal. The man received off label antiviral treatment with oral umifenovir [Arbidol] 200mg thrice a day. However, on hospital day 5, his respiratory distress worsened with percutaneous oxygen saturation of 89% despite face mask. He developed intermittent fevers and rales in both lungs. Repeat laboratory tests showed increased leukocyte count, procalcitonin and CRP. A chest CT scan revealed multiple patchy ground-glass opacities and consolidations of the inferior and middle lobes in both lungs with crazy paving pattern. On the basis of hypoxaemia severity, he was considered as the severe case of COVID-19 pneumonia. Therefore, he was given high flow nasal oxygen therapy (HFNO), off label treatment with IV methylprednisolone 80 mg/day for 3 consecutive days and intravenous immune globulin [immunoglobulin]. He also received Chinese herbs along with omeprazole and hydrotalcite for prevention of stress-induced gastrointestinal bleeding (GIB). Owing to suspected bacterial co-infection, he was given piperacillin/ tazobactam. His respiratory status gradually resolved after administration of these above medicines. On hospital day 9, a repeat chest CT scan showed no exacerbations of lesions. His oxygen saturation remained stable on supplemental oxygen. However, on admission day 17, he had passage of dark red stools and developed haemorrhagic shock. Laboratory tests revealed normocytic anaemia without coagulation dysfunction. Surprisingly, a repeat RT-PCR testing for COVID-19 infection was positive for stool specimen while negative for respiratory specimens. An abdominal CT scan and a CT angiography failed o revealed site and causes of GIB. He underwent IV resuscitation using isotonic sodium chloride, RBC tran
Data Loading...
