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Multiple Organ Dysfunction Secondary to Herpes Simplex Virus -1 Reactivation After Treatment With Dexamethasone and Sarilumab for Covid-19 Disease

Thomas Roe

Thomas Roe

University Hospitals Plymouth NHS TrustPlymouth, United Kingdom
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Roe, Thomas
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Sam Waddy

Sam Waddy

University Hospitals Plymouth NHS TrustPlymouth, United Kingdom
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Waddy, Sam
 et 
Nikitas Nikitas

Nikitas Nikitas

University Hospitals Plymouth NHS TrustPlymouth, United Kingdom
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Nikitas, Nikitas
  
08 mai 2023
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Catégorie d'article: Case Report
Publié en ligne: 08 mai 2023
Pages: 122 - 128
Reçu: 18 août 2022
Accepté: 08 févr. 2023
DOI: https://doi.org/10.2478/jccm-2023-0010
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© 2023 Thomas Roe et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Timeline of events throughout ICU admission. A. Biochemical results (CRP and Creatinine), B. Microbiology results, C. treatments (Blue: bacterial/antibiotic, Green: fungal/antifungal, Orange: viral/antiviral). D. Organ support: controlled mechanical ventilation (continuous line), proning (thick line), pressure support (dash line), and tracheostomy mask (dotted line). Cardiovascular support: noradrenaline infusion. Renal support: CRRT.
Timeline of events throughout ICU admission. A. Biochemical results (CRP and Creatinine), B. Microbiology results, C. treatments (Blue: bacterial/antibiotic, Green: fungal/antifungal, Orange: viral/antiviral). D. Organ support: controlled mechanical ventilation (continuous line), proning (thick line), pressure support (dash line), and tracheostomy mask (dotted line). Cardiovascular support: noradrenaline infusion. Renal support: CRRT.

Fig. 2.

Progression of facial rash A) day 8, B) day 17, and C) Day 30
Progression of facial rash A) day 8, B) day 17, and C) Day 30

Fig. 3.

Chest x-rays from A) day 8, B) day 17, and C) Day 30. D) Computed tomography pulmonary angiogram on day 9 demonstrating widespread ground glass appearances consistent with COVID pneumonitis.
Chest x-rays from A) day 8, B) day 17, and C) Day 30. D) Computed tomography pulmonary angiogram on day 9 demonstrating widespread ground glass appearances consistent with COVID pneumonitis.

Severity scores on admission, ogan support parameters and biochemical test values at key stages throughout ICU admission

Test Admission Day 7 Day 17: HSV-1 Positive Day 28: Completion of Acyclovir Day 49: ICU Discharge
Severity Score MODS 8 N/A N/A N/A N/A
SOFA 8 N/A N/A N/A N/A
APACHE-II 14 N/A N/A N/A N/A
Respiratory Support FiO2 (%) 60 35 70 35 21
PEEP (cmH20) 16 16 15 8 N/A
Pressure Support (cmH20) N/A N/A N/A 15 N/A
Mode of Ventilation Volume Control Volume Control Volume Control Pressure Support No Support
Cardiovascular Support Noradrenaline dose (mcg/kg/hour) 0 0 0.03 0 0
Renal Support Filtration Rate (ml/kg/hr) 0 0 25 0 0
Laboratory Findings Hb (g/L) 142 108 100 90 110
PLT (×109/L) 209 216 171 231 237
WCC (×109/L) 8.2 5.4 10.3 10.1 7.5
Neutrophils (×109/L) 7.3 3.9 7.1 7.4 4.7
Lymphocytes(×109/L) 0.6 1.3 2 1.7 2.3
PT (seconds) 12.9 13.4 14.3 15.9 N/A
APTT (seconds) 28.9 23.6 29.7 31.1 N/A
INR 1.0 1.1 1.1 1.1 N/A
Urea (mmol/L) 3.4 11 11.7 5.6 3.3
Creatinine (μmol/L) 67 57 101 47 48
eGFR (ml/min/1.73m2) >90 >90 58 >90 >90
Na+ (mmol/L) 136 143 144 141 137
K+ (mmol/L) 4.2 4 4.2 4.1 3.1
ALT (iu/L) 53 73 44 33 29
ALP (iu/L) 58 47 64 61 63
Bilirubin (μmol/L) 9 10 14 10 8
Albumin (g/L) 39 31 31 30 34
CRP 63 8 121 37 11
pH 7.4 7.54 7.41 7.45 N/A
Lactate (mmol/L) 1.6 1.8 1.7 1.6 N/A
pO2 (kPa) 9.7 8.7 12.6 8.7 N/A
pCO2 (kPa) 5.7 6.4 8.3 5.1 N/A
Langue:
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Sujets de la revue:
Médecine, Médecine clinique, Médecine interne, Médecine interne, autres, Chirurgie, Chirurgie, autres, Anesthésiologie, Médecine d'urgence et médecine intensive
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