Methotrexate/prednisolone/sulfasalazine

Abstract

Methotrexate/prednisolone/sulfasalazineSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia: case report A 49-year-old woman developed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia during treatment with methotrexate, prednisolone and sulfasalazine for rheumatoid arthritis [routes and durations of treatments to reaction onset not stated].The woman, who had a 15-year history of rheumatoid arthritis, had been receiving conventional first-line disease-modifyingantirheumatics comprising methotrexate [Ebetrex] 15 mg/week on Thursday and Friday, sulfasalazine 1000 mg/day and prednisolone [Nisopred] 5 mg/day. Concomitantly, she had been receiving calcium/vitamin-D [vitamin D-calcium] and ipratropium bromide [Ipravent]. On 11 March 2020, she was hospitalised in Iran due to fever, respiratory distress, dry cough, myalgia, dizziness and nausea. On admission, her oxygen saturation (SPO2%) was low (64%). Therefore, she received oxygen nebuliser, which led to the correction of the oxygen saturation to 87%. Four days prior to the admission, she only had dry cough without other symptoms. She did not have sign of reduced smell or taste senses. Before the admission, she came in contact with her two daughters, her husband and 1‐year‐old grandchildren and all of them were positive for COVID‐19 by real‐time PCR test. She was the only member of her family with severe respiratory problems that required hospitalisation (and also the only person with rheumatoid arthritis in her family), while the rest of the family showed mild symptoms and quarantined at home. On hospital day 1, a chest X‐ray on showed signs of pneumonia alongside with bilateral ground‐glass pattern, vascular dilation, and traction bronchiectasis in the middle and secondary lobes. Positive real‐time PCR tests confirmed the SARS‐CoV‐2 infection. Investigations on admission showed a very low WBC count and reduced number of platelets, as well as, elevated levels of erythrocyte sedimentation rate and prothrombin time.The woman was initiated on off-label treatment with hydroxychloroquine on hospital day 1 and it was continued for 10 days. Oseltamivir was added as off-label therapy on hospital day 2 and it was continued for 6 days. Her nausea [aetiology not stated] was controlled by ranitidine, ondansetron and pantoprazole. Lopinavir/ritonavir [Kaletra] 200-50 mg/day and night 2 tab each was added as off-label therapy on hospital day 4 and it was continued as the main antiviral medication for 7 days until symptoms were relieved. She was also treated with a cluster of unspecified antibacterials [antibiotics] for the first week due to a low WBC count and suppressed immunity (in order to prevent secondary infection). Theophylline [theophylline G] and oxygen nebuliser treatment were used to support the airway and reduce the respiratory symptoms. Her condition worsened at the end of first week. The WBC and RBC counts were found to decreased. A CT scan of the chest at the second week r...