CHENNAI: Kauvery Hospital Chennai announced the successful treatment of a doctor suffering from lung failure, owing to severe COVID-19 infection and 99 per cent lung involvement. The individual, a prominent surgeon from Vishakapatnam, was airlifted to Kauvery Hospital due to rapid worsening of his condition.
Speaking of the patient’s condition, Dr Srinivas Rajagopala, senior consultant, Interventional Pulmonology & Sleep Medicine and director, Transplant Pulmonology & Lung Recovery Unit, said, “He had a history of Myasthenia Gravis (a disorder characterised by weakness and fatigue of muscles due to an autoimmune disease) for which he was taking steroids and immunosuppressants. He was diagnosed with COVID-19 from the Omicron variant in the last week of January by gene sequencing and was treated with Remdesivir, steroids and Baricitinib in Vizag. There was no oxygen requirement at the point of diagnosis and CT scans showed only 40 per cent lung involvement. He was discharged within five days.”
After four days, he developed progressive breathing difficulty, high fever and chills and was readmitted to the same hospital. He soon needed oxygen, at 2-3 litres per minute. CT scans revealed 99 per cent lung involvement, with ongoing Covid-related damage. He was put on high-end antibiotics, high-dose steroids, anti-coagulation and Baricitinib. His condition, however, deteriorated with rising oxygen requirement, delivered through High Flow Nasal Cannula, which prompted the possibility of needing ECMO within the next 24 hours. The decision to refer him to Kauvery Hospital was taken and he was airlifted to Chennai immediately. The Kauvery team thoroughly perused his medical details and recognised that there was ongoing lung damage due to poor viral control by his over-suppressed immune system. Blood tests did not suggest any super-added infection.
“We de-escalated antibiotics, reduced steroid dosages and held his immunosuppression temporarily to clear the body of Covid infection. This was done with the consultation of the department of neurology, who were closely monitoring in case of a flare of myasthenia. With appropriate anti-virals and reduction in immunosuppressions, his condition stabilised. He was admitted to the ICU, follow-up blood tests also showed control of his initially high inflammatory markers, which slowly improved with good treatment.
We simultaneously continued ‘awake proning’, and supportive care with attention to nutrition and muscle strength. He had lung fibrosis that worsened during his hospital stay. Also, the CT scan of the chest suggested an organising pneumonia pattern. So a slow steroid taper was done with very good recovery in fibrosis by the time of discharge. Simultaneously, he was initiated on pulmonary rehabilitation which included cycling, treadmill, cardio, breath control and strength and endurance training” Dr Srinivas signed off.