PMC:7318948 / 3611-5910 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7318948","sourcedb":"PMC","sourceid":"7318948","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7318948","text":"On day 4, the fever subsided and vitals remained within normal limits. However, he developed increasing shortness of breath with new diffuse expiratory wheezes on physical exam. Repeat chest x-ray showed right lower lobe infiltrates and CT Thorax without contrast showed right upper, middle, and lower lobe infiltrates with ground glass appearance consistent with a viral pneumonitis. This later progressed to bilateral ground glass opacities as pictured in Fig. 1, Fig. 2, Fig. 3 and warranted transfer to the Intensive Care Unit (ICU). Test for COVID-19 serum antibodies performed at this time was positive for COVID-19 IgG antibodies. On Day 4, he received one dose of tocilizumab 4 mL/kilogram. Within 24 h of receiving this medication, his shortness of breath started to improve. His oxygen requirement dropped to 2–3 liters via nasal cannula with exercise while maintaining an oxygen saturation of 86–94 % over the next two days. His chest x-ray also showed improvement, as shown in Fig. 4 . Overall, he began to show clinical signs of improvement. Mycophenolic acid and tacrolimus were discontinued on day 5. Table 1 shows the lab results for the patient through the first seven days of his hospital stay.\nFig. 1 CT Thorax without contrast: bilateral ground glass opacities.\nFig. 2 CT Thorax without contrast: bilateral ground glass opacities.\nFig. 3 CT Thorax without contrast: bilateral ground glass opacities.\nFig. 4 Chest x-ray improved after six days of treatment.\nTable 1 Patient labs from Day 1–10.\nLabratory Test Results 4/11/20Day 1 4/13/20day 3 4/14/20day 4 4/15/20day 5 4/16/20day 6 4/17/20day 7 4/18/20day 8 4/20/20day 10\nWBC(4.5–11 × 109/L) 6.94 6.73 12.13 8.27 8.03 8.89\nLymphocytes(30–45 %) 2.90 % 3.70 % 3.30 % 6.50 %\nCreatinine(Male: 0.70−1.30 mg/dL) 1.20 1.30 1.50 1.10 1.00 0.90 0.90\nAST(10−40 units/L) 21 25 29 34 37 25 22\nALT(10−40 units/L) 29 26 28 45 64 53 51\nAlkaline phosphatase(30−120 units/L) 81 75 72 68 63 63 72\nLDH(80–225 units/L) 226.00 344.00\nC-reactive protein (\u003c0.8 mg/dL) 3.70 1.20 0.60\nIL-6(5−15 pg/mL) 18.2 670.8 392.8 280.7\nPrograf/ Tacrolimus 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