The patient reported initial improvement; however, on March 15 (day 9 of symptoms) fever recurred and supplemental oxygen by nasal cannula at a rate of 3 l per minute was required. Furthermore, both an increase in CRP levels (Table 1) and radiological deterioration were observed (Fig. 1 , a). These clinical changes suggested that the disease was progressing to an early phase of a hyperinflammatory state despite treatment with HCQ and LPV/r; thus, after assessing the safety profile of imatinib [3] and reviewing previous publications about its antiviral and immunomodulatory properties, we considered that this drug may have potentially beneficial effects in such clinical scenario. Hence, informed consent was obtained and imatinib (400 mg once daily) was added on day 12 of symptoms, while ceftriaxone was interrupted since there was no evidence of concurrent bacterial infection. Three days later the fever disappeared, supplemental oxygen was discontinued and radiological stability of pulmonary opacities was confirmed. Moreover, improvement in laboratory parameters was observed on day 5 of imatinib so it was stopped and the patient was subsequently discharged on day 16 of symptoms after also completing 9 days of HCQ and LPV/r. She remained asymptomatic on April 11 (20 days after discharge), her blood tests were then normal (Table 1) and pulmonary opacities had almost disappeared (Fig. 1, b).
Fig. 1 a Portable chest X-ray showing radiological deterioration with bilateral patchy opacities (March 17, day 11 of symptoms). b Marked improvement of opacities in posteroanterior chest radiograph (April 11, day 20 after discharge and day 36 after the onset of symptoms).