Abstract
There is worldwide concern for lack of specific therapy against the novel Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This case report presents the results of a pharmacological intervention aimed at modulating the inflammatory effects of coronavirus disease 2019 (COVID-19), in an effort to avoid the use of mechanical ventilation. A COVID-19 positive patient was admitted with multisystem organ dysfunction, including acute respiratory insufficiency, and was treated with a combination of low oral doses of hydroxychloroquine and intravenous N-acetylcysteine (NAC). The combination therapy resulted in noticeable clinical improvement and a quantifiable decrease of several of the inflammatory markers measured, in particular ferritin levels, C-reactive protein (CRP) and lactic acid. He also developed pulmonary embolism (PE) and deep vein thrombosis (DVT), both known side effects of COVID-19 infection. Following thrombolysis and heparinization his clinical evolution continued a positive trend until discharge. The therapeutic approach utilized in this case suggests that early intervention not only decrease acute organ dysfunction but also may decrease the need for mechanical ventilation in COVID-19 positive patients.
Highlights
There is worldwide concern for lack of specific therapy against the novel Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Any further responses from the reviewers can be found at the end of the article Background A novel coronavirus, SARS-CoV-2, isolated in January 20201 was implicated as the cause of COVID-19 that resulted in an outbreak of pneumonia in Wuhan, China
We previously demonstrated that restoring the capacity of the innate immune system by modulating neutrophil activity with hydroxychloroquine (HCQ) and N-acetylcysteine (NAC) was sufficient to ameliorate local tissue effects of cellular necrosis and inflammation[7] HCQ is a well-known therapy for certain inflammatory autoimmune diseases such as rheumatoid arthritis and lupus erythematosus and has significant impact on Toll-like receptor 9 (TLR-9) activity[8]
Summary
Case report We describe a 54-year-old Caucasian male patient, with past medical history significant for hypertension, hyperlipidemia, and obesity, who tested positive for SARS-CoV-2 by reversetranscriptase-polymerase-chain-reaction (RT-PCR) 11 days prior to his admission on mid April, 2020 (Table 1) at Holy Family Hospital in Methuen, Massachusetts. Following transfer from another hospital, he was admitted to the Intensive Care Unit with shortness of breath, body aches, fever, diaphoresis, tachypnea, low oxygen saturation of 92% requiring oxygen supplementation via non-rebreather mask, elevated lactic acid of 7.6 (0.5–2.2 mmol/L), and hyperglycemia with blood glucose of 402 (
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