A clinical case of COVID-19 infection in a young patient with a соmorbid pathology

Abstract

Background: The COVID-19 pandemic has caused a rapid increase in the number of cases and high mortality worldwide. Here we report a clinical case of severe COVID-19 with the development of lethal complications in a young patient with an unfavorable comorbid background. Description of the case: Patient R., a 36-year-old male, was admitted to the infectious diseases department with the complaints of frequent unproductive cough, pyretic body temperature, headache. Computed tomography of the chest revealed bilateral polysegmental pneumonia with the damage of up to 65% of the lung tissue. PCR for SARS-CoV-2 mRNA was positive. The medical history mentioned arterial hypertension for five years, obesity (BMI 41.5). The disease lasted for about 7 days, the patient took antipyretic, antibacterial medication without noticeable improvement. Despite the ongoing therapy for two days, the signs of pulmonary heart failure increased, culminating in the cardiac arrest, unsuccessful resuscitation and biological death of the patient. A sectional study revealed signs of pronounced edema in the lungs with a hemorrhagic component, hemolyzed erythrocytes were found in the lumen of the alveoli. In the heart, a histological examination revealed unevenly hypertrophied cardiomyocytes with areas of fragmentation. In the epithelium of the renal tubules, signs of karyorrhexis were found, and multiple areas of erythrocyte infiltration were found in the stroma. Conclusion: The clinical case demonstrates a rapid fulminant course of COVID-19 in a young patient with arterial hypertension and obesity, who developed viral-bacterial pneumonia, which led to the development of pulmonary heart failure, pulmonary edema, and necronephrosis.

Keywords

• covid-19
• arterial hypertension
• obesity
• pneumonia
• necronephrosis