Novel coronavirus 2019 (COVID-19)

Abstract

Rationale: Novel coronavirus 2019 (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped, non-segmented positive-sense RNA virus belonging to the beta-coronaviridae family. This virus is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing requiring mechanical ventilation and intensive care unit management. Patient concerns: A 77-year-old female with a history of hypertension and hyperlipidemia who presented as a transfer to our hospital facility with worsening fevers, cough, and respiratory distress. Diagnosis: Chest X-rays revealed bilateral infiltrates worse at the lung bases and CT scan of the chest showed bilateral ground-glass opacities consistent with COVID-19. While our testing revealed a negative COVID-19 result at our institution, the result at a previous hospital returned a positive result. Interventions: She was being treated aggressively in the intensive care unit with high dose intravenous ascorbic acid, hydroxychloroquine, and anti-interleukin-6 monoclonal antibody. She also received a loading dose of remdesivir however was unable to complete the course due to organ failure and requirement of vasopressors for hemodynamic stability. Outcomes: She remained critically ill and was eventually placed on comfort care as per the family's wishes and passed away. Lessons: With a rapidly growing death rate and more than 200,000 confirmed cases worldwide, COVID-19 has become a global pandemic and major hit to our healthcare systems. While several companies have already begun vaccine trials and healthcare facilities have been using a wide-range of medications to treat the virus and symptoms, there is not yet an approved medication regimen for COVID-19 infections. The alarming increase in cases per day adds additional pressure to find a cure and decrease the global health burden and mortality rate.

Anti-interleukin-6 monoclonal antibody for cytokine storm in COVID-19

“…[ 6 ] With the notion in mind of impairing the damage done by the host-immune system and acute-phase reactants, tocilizumab has been used as an off-label treatment in COVID-19. [ 4 ] In our patient presented, it was suspected the high-grade fevers and sudden increase in oxygen requirement were due to a cytokine storm. After receiving tocilizumab, there was a significant improvement of symptoms, and the patient had a successful recovery.…”

“…[ 2 3 ] While several medication regimens have gained recognition and are being used to treat COVID-19, tocilizumab, a recombinant humanized anti-interleukin-6 receptor monoclonal antibody, has been found to be effective in managing the cytokine storm. [ 4 ] We present the case of a young male diagnosed with COVID-19 infection with significant improvement of symptoms after receiving one dose of tocilizumab.…”

Vitamin C in the Treatment of COVID-19

“…He received vitamin C treatment together with inhalation therapy and supportive measures, but his status worsened despite these therapies and he died. Similarly, in another case-report, a 77-year-old female received high dose IV vitamin C (6 g for 2 times/day, then 1 g/day) together with antiviral and other treatments [ 28 ]. The patient developed organ failure and died despite these efforts.…”

A child with Henoch-Schonlein purpura secondary to a COVID-19 infection

“…SARS-CoV-2 is a single-stranded RNA virus responsible for COVID-19. 4 5 It often targets the respiratory system, with presentations ranging from a mild common cold-like illness to severe and potentially fatal conditions secondary to pneumonia, such as acute respiratory distress syndrome or septic shock. 5 COVID-19 can also result in extrapulmonary manifestations, including but not limited to cardiac, thrombotic and dermatological complications.…”