SARS-CoV-2 atypical viral pneumonia with 25/25 computed tomography score

Abstract

A-36-year-old female patient came to the emergency department the complaints of fever with chills, along with progressing breathing difficulty since 8 days. She was advised rapid antigen test on 22/04/2021 and a sample was taken for reverse transcription polymerase chain reaction (RT-PCR), both came out to be positive for SARS-CoV-2. Following this, her high-resolution computed tomography (HRCT) thorax (A) was done which reveals multiple ill-defined patchy ground-glass opacities with consolidation, septal thickening, and fibrotic changes in bilateral lung fields as described above signs suggestive of COVID-19 changes with atypical viral pneumonia. The computed tomography (CT) severity score was 25/25 (severe) with COVID-19 Reporting and Data System (CO-RADS) grade 6. The patient was immediately admitted to the isolation intensive care unit (ICU). High flow O₂ support was started as SpO₂ on admission was 44% on room air. Despite high flow of O₂, patient was breathless and SpO₂ was 57%. She was hence taken on bilevel positive airway pressure (BiPAP) with a 14-8 setting with O₂ support. Along with medical management, physiotherapy treatment was administered. After 22 days the RT-PCR was reported negative and was shifted to high dependency unit and advised chest X-ray (B) which suggestive of bilateral opacities seen in bilateral lobes and right hemi diaphragm is pulled up. She received regular physiotherapy and was gradually wean off from ventilator and was maintaining saturation at the flow rate of 15 litre O₂/min. Early administration of rehabilitation program will help in prevent further complications among such patients.