Table 2 Affected organ systems and therapeutic measures
From: Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection
Affected organ system / Medical problem | Diagnostics / Results | Therapy |
|---|---|---|
Severe acute respiratory distress syndrome (ARDS) with PaO2/FiO2 ratio as deep as 80 | CT scan thorax / bilateral ground-glass infiltrates of the lungs, pleural effusions | Prone positioning Nitric oxide therapy |
Co-infections causing pneumonia and sepsis | - ventilator associated pneumonia with Proteus vulgaris and sepsis - viral pneumonia with Herpes simplex virus 1 - catheter infection with Staphylococcus epidermidis | Thoracic drain Antimicrobial therapy |
Acute kidney injury (AKI) | Kidney biopsy / granulomatous tubulointerstitial nephritis | Continous veno-venous hemodiafiltration Discontinuation of beta-lactams & proton pump inhibitor Corticosteroid therapy |
Encephalopathy | - CT and MRI head / multiple intracranial microhemorrhages - EEG/ no epileptic activity | Termination of unnecessary medication Temporary reduction of anticoagulation Physiotherapy |
Hemodynamic instability | ECG / Intermittent atrial fibrillation Echocardiography / left ventricular function within normal limits | Vasopressors Amiodarone Electric cardioversion Therapeutic anticoagulation |
Hemolytic anemia | Laboratory testing/ Coombs test negative, ADAMTS 13 normal, Blood immunophenotyping/ no evidence of paroxysmal nocturnal hemoglobinuria | Transfusion of packed red blood cells Discontinuation of imipenem and amiodarone Corticosteroid therapy |
Local bleeding after tracheostomy without hemodynamic instability | Clinical examination | Transfusion of packed red blood cells Mechanical compression |
Critical illness polyneuropathy | Diffuse, symmetric, flaccid paresis, muscle weakness | Physiotherapy, discharge to rehabilitation facility |
Hepatopathy | Hepatitis B and C negative No cholestasis on imaging | Reduction of hepatotoxic medication |
Maculopapular rash | Skin biopsy / dermoepidermal junction with focal vacuolization; lymphocytic infiltrates and rare eosinophils within the corium, discrete vasculitic changes and extravasates of erythrocytes; consistent with drug-induced exanthema; negative for SARS-CoV-2 | Corticosteroids topically and systemically |