Severe COVID-19 Infection While on Long Standing Therapy with Hydroxychloroquine

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic has placed a large demand on healthcare resources worldwide. Hydroxychloroquine is reported as an agent with potential benefit in prophylaxis and treatment and is being used for both. The authors hereby present the case of 63-year-old male patient with myasthenia gravis and 22-year-old female patient with mixed connective tissue disease, both on chronic therapy with hydroxychloroquine, who were admitted to intensive care with severe Acute Respiratory Distress Syndrome (ARDS) and COVID-19 infection. The patients had typical symptoms of fever, cough and dyspnea with lymphopenia on blood investigations. They were intubated and mechanically ventilated, requiring paralytics and proning, with subsequent dramatic improvement in oxygenation noted. This is the first report to describe the development of SARS-CoV-2 infection in patients already on hydroxychloroquine and demonstrates the need for robust clinical studies before we can recommend its use for routine prophylaxis in healthcare workers or exposed patient contacts.