Document resource
A man in his early 60s with no relevant medical history was admitted to intensive care with severe acute respiratory failure due to COVID-19 pneumonia. He required immediate intubation and mechanical ventilation. Imaging showed bilateral ground-glass opacities. Laboratory tests revealed elevated inflammatory markers, lymphopenia and coagulopathy. He received lung-protective ventilation, prone positioning, neuromuscular blockade, vasopressors and subcutaneous enoxaparin 40 mg daily. Despite initial improvement, he developed multiorgan dysfunction: acute kidney injury requiring renal replacement therapy, hepatocellular dysfunction (peak aspartate aminotransferase 458 U/L, alanine aminotransferase 372 U/L, bilirubin 6.3 mg/dL) and worsening haemodynamic instability. Peak creatinine and urea were 4.2 mg/dL and 184 mg/dL. Repeated cultures and imaging excluded viral, bacterial and fungal infections. Cytomegalovirus and herpes simplex virus PCR were negative. Glucose was controlled; propofol use was not prolonged.