Patient with severe COVID-19 treated with corticosteroids

Treatment with corticosteroids for COVID-19 and ARDS (acute respiratory distress syndrome) is controversial and has generally not been recommended.

A woman in her sixties was admitted to hospital after ten days of flu-like symptoms. She was confirmed as Sars-CoV-2-positive and experienced a steady decrease in oxygen saturation (SaO2), despite being given increasing amounts of supplemental oxygen. On day three she was intubated and placed on a ventilator. She had a three-phased trajectory where ventilation was extremely challenging, prone positioning and permissive hypercapnia were necessary, and inflammation markers increased. There was no improvement in the third phase, and on day 19 on the ventilator, we decided to give her corticosteroids. Two days later she could be weaned from the ventilator.

In our patient with severe ARDS from COVID-19, we saw rapid improvement after she was given corticosteroids, and her case is a contribution to the discussion regarding use of corticosteroids for the most severely ill COVID-19 patients.