Abstract
Background: Since the late 2019, SARS-CoV2 has spread worldwide, leading WHO to declare a pandemic state. Italy resulted deeply affected by the infection, especially the North. Although there is no proven specific treatment for the infection and for the pulmonary disease, several molecules have been tested always comparing efficacy and collateral effects. Oxygen support plays a key role in the management of this type of patients along with the collaboration with intensive care specialists. This case regards a COVID-19 patient whose clinical parameters deteriorated few days after admission and who had been treated with both Tocilizumab and High Flow Nasal Oxygenation. Case presentation: A 55 yo caucasian female was admitted to ED because of fever and dyspnea. Her chest X-ray showed bilateral ground glass areas and blood examinations revealed elevated inflammatory markers along with lymphopenia. RT-PCR for SARS-CoV2 resulted positive and the patient was transferred to our Unit. We started administration of antiviral therapy with Lopinavir/ritonavir, hydroxychloroquine plus azithromycin, along with antibiotic therapy and anticoagulant treatment. Despite the therapy, her clinical conditions started deteriorating together with chest X-ray findings and arterial blood gas parameters. Inflammatory markers were elevated too. We started High Flow Nasal Cannula Oxygenation (HFNC) along with Tocilizumab administration. In two days, respiratory frequency and arterial blood gas data were ameliorated and chest X-ray improved too. In six days, she started waning HFNC and, after ten days, she stopped. Due to the important clinical and radiological amelioration along with two negative results on RT-PCR for SARSCoV2, the patient was discharged. Conclusions: It is indisputable that we need more data and guidelines about COVID19 therapies that lead us through the correct clinical behavior to guarantee the best treatment for these patients
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