ABSTRACT
Background: SARS-CoV-2 can determine pneumonia and multiorgan damage due to systemic inflammation. Description of the case: A 51-year-old man was admitted to our CoViD-19 ward for diabetic acidosis and positive SARS-CoV-2 test. The patient had type 1 diabetes mellitus and he was taking insulin. Three days before this admission, he had presented nausea. The first day, after that acidosis was managed with intravenous infusion of insulin and bicarbonate, the patient referred dyspnea while he was breathing ambient air and a chest CT scan was performed with evidence of interstitial pneumonia and multiple bilateral consolidation areas. Supplemental oxygen and antibiotic plus antiviral therapy (remdesivir) were started. During the hospitalization, the patient faced progressive anemia and blood transfusions were administered. For deterioration of respiratory function, noninvasive ventilation was applied. Laboratory exams showed leukocytosis, renal insufficiency, PCR and D-dimer increased. Also cardiac troponin showed a sharp rise;therefore ECG, echocardiography and coronarography were performed with diagnosis of critical stenosis of left anterior descending artery. Cardiac stent was placed, obtaining troponin reduction and cardiac kinesis recovery. In the following days, patient showed progressive improvement of lung inflammation, allowing us shifting to low flow Venturi mask oxygenation. Conclusions: This case shows how complex can be a CoViD-19 patient with metabolic alterations and severe damage to vital organs (as lung, heart and kidney) that request a multidisciplinary approach.