Case history:
A 42-year-old woman with Down’s Syndrome, a background of hypothyroidism on L-thyroxine, and diabetes mellitus developed a fever on 10th January 2022, and the next day, she had mild cough associated weakness. She had no history of vaccination against COVID-19. On 12th January 2022, she underwent a COVID-19 test and became positive; the same day, she started tab Azythromycin 500mg once daily, tab Motelukust 10mg once at night and tab paracetamol 500 mg 8 hourly as physician advised. Her vital was within the standard limit the following week except for temperature. She was admitted to the COVID-19 department, Feni hospital, on 21st January 2022, with respiratory distress progressively worsening over the last few days and was accompanied by fever, myalgia, and cough. At the time of the patient’s admission, the clinical assessment was done, which revealed neurological stability with a Glasgow score of 15/15, body temperature of 38.2 degrees Celsius with a heart rate of 98 beats per minute, blood pressure (BP) of 130/80 mmHg, peripheral oxygen saturation (SpO2) at ambient air (AA) of 95 per cent with Arterial blood gas test (Table: 01) and underwent routine and relevant investigation (Table: 01). Then she was referred to Chittagong hospital due to better facilities and got admitted on 25th January 2022. Again, they do, the nasopharyngeal swab PCR test for SARS-CoV-2 was negative on that day, but a CT scan (computerized tomography) revealed bilateral ground-glass pneumonia with an estimated 30 per cent parenchymal involvement and no sign of pulmonary embolism (Figure: 01). She again did the blood test and urine test (Table:01) and started the treatment as per protocol (Table:02), including continuous positive airway pressure (CPAP). She was transported to the cabin on 1st February 2022, with oxygen delivery at a rate of 2-3 L per minute through a nasal route due to her improved respiratory status. She was later discharged on 6th February 2022 with medication and respiratory exercise with stable conditions.