Prednisolone
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COVID-19 pneumonia: case report A 58-year-old man developed COVID-19 pneumonia during treatment with prednisolone for chronic obstructive pulmonary disease (COPD) exacerbation [route not stated]. The man had COPD and a smoking history of 38 pack-years. He had a fever of 38°C seven days before hospital admission in March 2020. He was prescribed loxoprofen [loxoprofen sodium] at home. However, his malaise and fever persisted. He had dyspnoea 1 day before admission. Subsequently, he was brought to the emergency department of hospital. Upon arrival, marked hypoxaemia with 55% oxygen saturation (SpO2) at room air was noted. Blood biochemistry showed high inflammatory response with elevated CRP and lymphocytopenia. Chest X-ray indicated decreased lung permeability because of ground-glass shadows. Chest CT scan revealed bilateral ground-glass opacity with significant emphysematous changes and bilateral pleural effusion. His SpO2 was 84% despite oxygen administeration at 12 L/min. Endotracheal intubation was done and he was transferred to the ICU for ventilator management. He then received IV infusion of piperacillin/tazobactam 4.5g every 8 hours as empiric therapy for severe pneumonia. He also received azithromycin via nasogastric tube for 3 days. A tendency for CO2 retention in his arterial blood gas was observed and COPD exacerbation was diagnosed. He then received treatment with prednisolone 30mg per day for 5 days to control exacerbation of COPD. On day 4 of hospitalisation, he was tested positive for a SARS-CoV-2 PCR assay, and he was diagnosed with COVID-19 pneumonia. He received off-label treatment with oral favipiravir on the same day. On day 1 of treatment, he received favipiravir 1800mg every 12 hours and from day 2, 800mg every 12 hours was given via nasogastric tube. As his D-dimer level tended to elevate post admission, venous thromboembolism was suspected, and he started receiving continuous IV heparin infusions. His respiratory condition improved on day 5 of hospitalisation and the ventilatory support was discontinued. On day 10 of hospitalisation, his chest X-ray findings and symptoms improved, therefore treatment of antibiotics (piperacillin/ tazobactam) was discontinued. On day 13 of hospitalisation, a contrast-enhanced CT scan confirmed the presence of deep vein thrombosis and pulmonary embolism. The IV continuous infusion of heparin was switched to edoxaban. Also, his WBC tended to decrease. Treatment with favipiravir was discontinued on day 13. On day 15 of hospitalisation, he tested negative for a SARS-CoV-2 PCR test. On day 19 of hospitalisation, oxygen therapy was stopped. His chest CT images were found to be improved and he was discharged on day 21. His blood seropositivity for SARS-CoV-2 antibodies which was negative for IgM and IgG on admission turned out to be positive on day 7 and 15 for IgM and IgG. His blood seropositivity for SARS-CoV-2 antibodies sustained on day 54 during his visit at the outpatient clinic. Inoue H, et al. Combination treatment of short-course systemic corticosteroid
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