Abstract

The patient was a 72-year-old woman who developed headache, fever, dyspnea, and taste disorder over a three-day period. A COVID-19 polymerase chain reaction (PCR) test was positive. As she was elderly and required oxygen supplementation, and was therefore admitted to our hospital on day 7 after the onset of headache. Her relevant past history included hypertension, which was treated by enalapril maleate. She was initially treated by dexamethasone (6 mg) per day, remdesivir and heparinization. However, her oxygenation deteriorated and she was transferred to the intensive care unit after tracheal intubation and mechanical ventilation on the 6th hospital day. Her initial PaO₂/FiO₂ (P/F) value was 150. She underwent additional treatment with glycyrrhizin and γ-globulin on the same day. Her P/F value fluctuated from <200 to the 260 within one day. She underwent tracheotomy on the 13th hospital day, and steroid pulse therapy (methylprednisolone [1 g per day for 3 days]) was administered on the 14th hospital day, following the administration of methylprednisolone (10 mg). Mechanical ventilation was withdrawn from the 19th hospital day. On the 27th hospital day, she was moved to a general ward with 2 L/min of oxygen. Consideration regarding the necessity of steroid pulse therapy is the key to the treatment of COVID-19 patients with ARDS. The indication of pulse steroid therapy, including the dosage duration, and subsequent steroid treatment is a further clinical question in relation to the treatment of COVID-19-induced ARDS.