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A Cured Coronavirus Disease 2019 Case of an 86-Year-Old With 13 Chronic Diseases: A Case Report

  • Yanhong Tu
    Affiliations
    Department of Gastroenterology, Affiliated Hospital of Jianghan University, Wuhan, People’s Republic of China
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  • Ji Fang
    Affiliations
    Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, People’s Republic of China
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  • Menghui Yin
    Affiliations
    State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Guangzhou, Guangdong, People’s Republic of China
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  • Weizhong Yu
    Correspondence
    Corresponding author. Address for correspondence: Weizhong Yu, MD, Department of Gastroenterology, Affiliated Hospital of Jianghan University, Wuhan 430015, People’s Republic of China.
    Affiliations
    Department of Gastroenterology, Affiliated Hospital of Jianghan University, Wuhan, People’s Republic of China
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  • Yinxiong Li
    Affiliations
    State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Guangzhou, Guangdong, People’s Republic of China
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Open AccessPublished:April 04, 2020DOI:https://doi.org/10.1016/j.jtocrr.2020.100038

      Introduction

      An outbreak of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that began in Wuhan, China, resulted in the disease being named coronavirus disease 2019 (COVID-19). Presently, there are more than 400,000 cases and 18,000 deaths worldwide owing to the COVID-19 outbreak that poses a big challenge to therapy.
      • Tian S.
      • Hu W.
      • Niu L.
      • Liu H.
      • Xu H.
      • Xiao S.Y.
      Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer.
      In this pandemic, aged patients who suffer from severe pneumonia and have multiple chronic diseases are the most susceptible population and have the highest fatality rate.
      • Wu C.
      • Chen X.
      • Cai Y.
      • et al.
      Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China [e-pub ahead of print]. JAMA Intern Med.
      Hence, elderly patients need special attention and effective care.

      Method

      A review of clinical history was conducted.

      Results

      On January 22, 2020, an 86-year-old man who claimed to have had fever for 2 days and cough history arrived in the hospital with a body temperature of 38.8°C. He was found to have multiple chronic diseases, including unstable angina, cardiomegaly, cardiac function level II, lacunar infarction, cerebral arteriosclerosis, hypertension level III, hypertensive cardiopathy, senile heart valve disorders, calcification of aortic valve, type 2 diabetes mellitus, hypoproteinemia, chronic kidney disease stage II, and chronic pancreatitis. Typical ground-glass opacities were found in his computed tomography scan in the posterior, back, and basal segments of the left apex of the lung and on the base of the right lung (Fig. 1). Furthermore, a mass-like density and reversed halo signs were found located mostly at the subpleural and periphery of the lung. The SARS-CoV-2 infection of this patient was confirmed by real-time polymerase chain reaction on January 29, 2020. As a countermeasure, conventional anti-infection and antiviral treatments were initiated, combined with a 1-day intravenous drip of methylprednisolone to prevent a cytokine storm from developing. Also, an intravenous infusion of human immunoglobulin injection was administered to improve the body’s immunity. The patient’s body temperature kept fluctuating between 36.4°C and 37.9°C and became normal on January 30, 2020. Nevertheless, the patient lost his appetite, and a nasogastric feeding tube was used to provide comprehensive nutritional treatment with a nasogastric enteral nutrient solution. During the treatment period, a computed tomography scan recheck (Fig. 2) revealed reduced density of lesions in both the lungs on January 27, 2020. A fecal occult blood test conducted 14 days later revealed blood in the stool (4+). After considering it might result from stress ulcer, an injection of pantoprazole was given to suppress the gastric acid and protect the gastric mucosa. This stopped the bleeding 2 days later. On February 15 and 19, 2020, the oropharyngeal swab specimens processed through real-time reverse-transcriptase polymerase chain reaction revealed negative results for SARS-CoV-2.
      Figure thumbnail gr1
      Figure 1Computed tomography scan images of the patient on January 22, 2020, that revealed ground-glass opacities in bilateral lungs.
      Figure thumbnail gr2
      Figure 2Computed tomography scan images of the patient on January 27, 2020, that revealed reduced density of lesions in bilateral lungs.

      Conclusions

      This optimal therapeutic regimen should be formulated for aged patients with COVID-19 and multiple chronic diseases to control the symptoms and benefit the patients. However, the effect of pantoprazole was inconclusive, and the case requires further evaluation in the treatment of COVID-19.

      Acknowledgments

      Supported by the Emergency and special research project for prevention and control of COVID-19 from Guangdong province (2020B111117001), The National Key Research and Development Program of China ( 2020YFC0842400 ), Guangzhou Regenerative Medicine and Health Guangdong Laboratory ( 2018GZR110105011 ), National Natural Science Foundation of China ( 81803802 ), and Guangzhou Development District Postdoctoral Science Foundation ( Y88B051 ).

      References

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        WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020.
        (Accessed February 11, 2020)
        • Tian S.
        • Hu W.
        • Niu L.
        • Liu H.
        • Xu H.
        • Xiao S.Y.
        Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer.
        J Thorac Oncol. 2020; 15: 700-704
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        Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China [e-pub ahead of print]. JAMA Intern Med.
        (accessed March 13, 2020)