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Case Reports
. 2020 Sep 23;7(1):e569.
doi: 10.1002/ams2.569. eCollection 2020 Jan-Dec.

Late i.v. steroid treatment for severe COVID-19-induced acute respiratory distress syndrome: a case report

Yasuaki Kumakawa  1 , Yohei Hirano  1 , Koichiro Sueyoshi  1 , Tadashi Ishihara  1 , Yutaka Kondo  1 , Takaaki Kawasaki  1 , Yuji Takeuchi  1 , Yuki Nakamura  1 , Kouhei Ishikawa  1 , Yusuke Watanabe  2 , Wataru Saito  2 , Shigeru Matsuda  1 , Takeshi Nakazawa  3 , Shinichi Sasaki  3   4 , Ken Okamoto  1 , Tanaka Hiroshi  1
Affiliations
Case Reports

Late i.v. steroid treatment for severe COVID-19-induced acute respiratory distress syndrome: a case report

Yasuaki Kumakawa et al. Acute Med Surg. .

Abstract

Background: The efficacy of steroid treatment for coronavirus disease (COVID-19) is unknown.

Case presentation: A 67-year-old man was transported to our hospital due to impaired consciousness and respiratory failure. After admission, tracheal aspirate of the patient was harvested, and it tested positive for severe acute respiratory syndrome coronavirus 2 nucleic acid. He required veno-venous extracorporeal membrane oxygenation to sustain his oxygenation. However, his respiratory failure did not improve for 20 days. On day 20 of admission, we started to use i.v. steroid therapy. On day 23, lung opacity on the chest X-ray cleared and the patient's oxygen saturation improved significantly. We successfully removed extracorporeal membrane oxygenation on day 27.

Conclusion: Our case report encourages more future trials to evaluate the therapeutic use of i.v. steroid in severe COVID-19-induced acute respiratory distress syndrome.

Keywords: ARDS; COVID‐19; ECMO; SARS‐CoV‐2; steroid.

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Conflict of interest statement

Approval of the research protocol: The ethics committee at our institution approved the publication of this case report. Informed consent: Consent for publication was obtained from the patient’s family. Registry and registration no. of the study: N/A. Animal studies: N/A. Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Clinical course of a 67‐year‐old man during hospitalization for severe COVID‐19‐induced acute respiratory distress syndrome. After initiation of corticosteroid treatment on day 20 of hospitalization, partial pressure of arterial oxygen (PaO2) gradually improved and inflammatory marker C‐reaction protein (CRP) decreased. Fraction of inspired oxygen (FiO2) of the ventilator was set at 1.0 before extracorporeal membrane oxygenation (ECMO) deployment. During and after ECMO support, FiO2 was set at 0.4. CEZ, cefazolin; CRP, C‐reaction protein; CRRT, continuous renal replacement therapy; FER, ferritin; IL‐6, interleukin‐6; LVFX, levofloxacin; LZD, linezolid; MEPM, meropenem; m‐PSL, methylprednisolone; PIPC, piperacillin; PSL, prednisolone; TAZ, tazobactam; VV‐ECMO, veno‐venous ECMO.
Fig. 2
Fig. 2
Chest computed tomography (CT) and chest X‐ray images in time series of a 67‐year‐old man during hospitalization for severe COVID‐19‐induced acute respiratory distress syndrome. A, Chest CT on day 1 shows bilateral basal consolidation with peripheral ground‐glass opacity. B, Chest X‐ray on day 1 shows bilateral pulmonary infiltrate mainly in hilar region. C, Chest X‐ray on day 20 shows bilateral diffuse pulmonary infiltrates with air bronchogram. D, Chest X‐ray on day 23 shows improved bilateral lung opacity (mainly in the right lobe of lungs). E, Chest X‐ray on day 31 (extracorporeal membrane oxygenation removed). F, Chest X‐ray on day 52 (ventilator removed).
See this image and copyright information in PMC

References

    1. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019‐nCoV lung injury. Lancet 2020; 395: 473–5. - PMC - PubMed
    1. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID‐19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033–4. - PMC - PubMed
    1. Asakura H, Ogawa H. Potential of heparin and nafamostat combination therapy for COVID‐19. J. Thromb. Haemost. 2020; 18: 1521–2. - PMC - PubMed
    1. Kimmoun A, Roche S, Bridey C, et al Prolonged prone positioning under VV‐ECMO is safe and improves oxygenation and respiratory compliance. Ann. Int. Care 2015; 5: 35. - PMC - PubMed
    1. Arabi YM, Mandourah Y, Al‐Hameed F, et al Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. Am. J. Respir. Crit. Care Med. 2018; 197: 757–67. - PubMed

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