Coronavirus Disease 2019 (COVID-19) Complicated by Acute Respiratory Distress Syndrome: An Internist's Perspective

Abstract

A pandemic outbreak of a novel coronavirus disease (COVID-19) that began in Wuhan, China, in December 2019 has spread rapidly to multiple countries. In the United States, the first confirmed case was reported on January 20, 2020, and since then, the number of cases is rising exponentially on a daily basis. We report a case of COVID-19 infection that presented with symptoms suggestive of pneumonia. Due to the major backlog with an immense number of pending tests, it took 48 hours for the result to come back positive, while the patient went into acute respiratory distress syndrome. We provide an internist's perspective of the difficulties encountered in terms of the available management options, as the patient progressively deteriorated on the regular medical floor prompting transfer to the intensive care unit.

Keywords: acute respiratory distress syndrome; ards; coronavirus disease 2019; corticosteroids; covid-19; nebulizer; pandemic.

Figure 1. Electrocardiogram showing atrial fibrillation with complete right bundle branch block

Figure 2. Chest X-ray on presentation showing hazy right upper lobe opacity (red arrow) with increased prominence of right hilum indicating adenopathy or inflammatory changes (green arrow)

Figure 3. Chest X-ray on day 2 of admission revealing worsening infiltrates in bilateral lung zones

Figure 4. Transthoracic echocardiogram showing normal biventricular size and function in parasternal long axis (red arrows), parasternal short axis (yellow arrows), and apical four chamber (blue arrows) views