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COVID-19 complicated with pneumonia in a patient with rheumatoid arthritis: Case Study Report

In December 2019, numerous coronavirus disease 2019 (COVID-19) cases were reported in Wuhan, China, which has since spread throughout the world. However, its impact on rheumatoid arthritis (RA) patients is unknown. Herein, we report a case of COVID-19 pneumonia in a 61-year-old female RA patient who was receiving conventional disease-modifying anti-rheumatic drugs (cDMARDs). The patient presented with a 4-day history of myalgia and febrile sensation. COVID-19 was confirmed by real-time polymerase chain reaction (PCR). Chest X-ray showed increased opacity on the right lower lung area, and C-reactive protein level was slightly elevated. The patient was treated with antiviral agents (lopinavir/ritonavir), and treatment with cDMARDs was discontinued except hydroxychloroquine. Her symptoms and laboratory results gradu-ally improved. Three weeks later, real-time PCR for COVID-19 showed negative conversion, and the patient was discharged without any complications.

CAse Study Report

A 61-year-old woman visited our hospital complaining of myalgia and febrile sensation for 4 days. Eight days before her visit to our hospital, she had contact with her daugh-ter, who was confirmed to be COVID-19-positive 2 days before that hospital visit. The patient was diagnosed with RA at a local clinic 3 years ago, and disease remission was achieved after treatment with leflunomide (20 mg per day), hydroxychloroquine (200 mg per day), methylprednisolone (2 mg per day), meloxicam (7.5 mg per day), famotidine (20 mg per day), and folic acid (1 mg per day). The patient denied any smoking and alcohol drinking habits.On admission, the patient had no respiratory symp-toms, and her vital signs were as follows: blood pressure, 169/79 mmHg; heart rate, 80 beats/min; body temperature, 37.6 °C; and respiratory rate, 20 breaths/min. On physical examination, no pharyngeal injection and clear lung sounds were observed. The initial laboratory tests revealed that the complete blood count, liver function markers, and C-reactive protein level were within the normal range [Table 1, hos-pital day (HD) 1]. A chest X-ray also showed no abnormal findings (Fig. 1a). Blood culture and tests for Streptococcus pneumoniae, Mycoplasma pneumonia, Chlamydia pneumo-niae, Legionella pneumophila, Mycobacterium tuberculosis, and human immunodeficiency virus (HIV) were all negative. However, COVID-19 was confirmed by polymerase chain reaction (PCR) using PowerChek 2019-nCoV Real-time PCR kit (KogeneBiotech Co. Ltd., Seoul, Korea).Three days after admission, the patient developed a dry cough, scanty sputum, and sore throat without any severe respiratory symptoms, such as shortness of breath or chest pain. The C-reactive protein levels were slightly elevated (Table 1, HD 3), and chest X-ray showed the haziness on the right lower lung area (Fig. 1b), suggesting the development of COVID-19 pneumonia.The patient was treated with lopinavir/ritonavir for 10 days; 2 tablets (lopinavir 200 mg/ritonavir 50 mg) were given twice per day (Fig. 2). Of the RA medications, leflu-nomide and methylprednisolone were discontinued; how-ever, the patient continued receiving hydroxychloroquine, meloxicam, and famotidine. After the antiviral treatment, her symptoms gradually improved, and 10 days after admission, her C-reactive protein levels returned to normal (Table 1, HD 10). Twenty-four days after admission, real-time PCR could not detect the nucleic acid of SARS-CoV-2, and the patient was discharged without any complications.

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