Zhou et al. BMC Infectious Diseases (2020) 20:824 https://doi.org/10.1186/s12879-020-05545-y CASE REPORT Open Access First patient management of COVID-19 in Changsha, China: a case report Jian Zhou1†, Ziqin Cao1†, Wanchun Wang1, Kang Huang2, Fang Zheng2, Yuanlin Xie2, Dixuan Jiang2* and Zhiguo Zhou2* Abstract Background: In December 2019, the novel coronavirus disease 2019 (COVID-19) emerged in Wuhan, Hubei Province, China. It rapidly spread and many cases were identified in multiple countries, posing a global health problem. Here, we report the first patient cured of COVID-19 infection in Changsha, China, and the symptoms, diagnosis, treatment, and management of this patient are all described in this report. Case presentation: A 57-year-old woman developed cough and fever after returning to Changsha from Wuhan on January 9, 2020. She tested positive for COVID-19 infection, a diagnosis which was supported by chest CT. The patient was treated with lopinavir and ritonavir tablets and interferon alfa-2b injection. A low dose of glucocorticoids was used for a short period to control bilateral lung immune response, and this patient avoided being crushed by cytokine storms that might have occurred. The clinical condition of this patient improved, and a COVID-19 assay conducted on January 25, 2020 generated negative results. This patient recovered and was discharged on January 30, 2020. Conclusions: Currently, there are numerous reports on COVID-19 infections focusing on the disease’s epidemiological and clinical characteristics. This case describes the symptoms, diagnosis, treatment, and management of a patient cured of COVID-19 infection, which may serve as reference for future cases, while further studies are needed. Keywords: Cured patient, COVID-19, China, Case report Background COVID-19’sepidemiological clinical features were re- Coronavirus disease 2019 (COVID-19) infections can ported in several studies [4, 6, 7]. The first case of lead to severe respiratory disease. At the beginning of COVID-19 infection in the United States was reported December 2019, a cluster of patients with COVID-19 on January 20, 2020, and the clinical condition of this infection was reported in China [1, 2, 3]. A previous re- patient apparently improved following treatment with port on COVID-19 indicated that human-to-human intravenous remdesivir [8]. In this report, we describe transmission of COVID-19 had been occurring [4]. By the symptoms, diagnosis, treatment, and management of August 31, 2020, a cumulative total of nearly 25 million the first patient cured of COVID-19 infection in Chang- cases and 800,000 deaths have been reported [5]. sha, China. * Correspondence: [email protected]; [email protected] Case presentation †Jian Zhou and Ziqin Cao contributed equally to this work. On January 16, 2020, a 57-year-old woman came to the 2 Department of Respiratory Medicine, The First Hospital of Changsha City, emergency department of the First Hospital of Changsha No.311 Yingpan Road, Kaifu District, Changsha 410005, Hunan Province, China City, China. After 10 min, she was taken into the exam- Full list of author information is available at the end of the article ination room and evaluated by the emergency physician. © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zhou et al. BMC Infectious Diseases (2020) 20:824 Page 2 of 6 The chief complaints of this patient were cough and oxygenation index closely. When the patient’s blood fever, with general weakness and muscle aches that de- oxygen saturation is below 93%, respiratory support is veloped after returning to Changsha from Wuhan 7 days given. This patient has not reached the point where prior. Given her symptoms and recent travel history, she tracheal intubation is required, so respiratory support decided to see a health care provider. The patient had a was not given to this patient. history of hypertension, carotid plaque, hypothyroidism, On hospital day 4 (illness day 10), re-examination of the and chronic gastritis, without a smoking or drinking lung CT showed that lung inflammation had progressed habit. The physical examination revealed the following: (Fig. 1b). The dose of methylprednisolone sodium succin- body temperature: 38.0 °C, blood pressure: 143/76 ate was changed to 40 mg Q12H intravenously, and intra- mmHg, pulse: 78 beats per minute, respiratory rate: 13 venous human immunoglobulin (Ph4) 5 g BID was added breaths per minute, and oxygen saturation: 96%. She had to inhibit lung inflammation. Given the clinical presenta- throat congestion and thick bilateral breath sounds in tion, treatment with piperacillin sodium and tazobactam the lungs. To evaluate the abnormal breath sounds, we sodium (4.5 g Q8H intravenously) and moxifloxacin performed a chest CT examination, which revealed bilat- hydrochloride and sodium chloride injection (0.4 g QD eral pneumonia (Fig. 1a). The results of nucleic acid intravenously) were initiated. amplification testing (NAAT) for influenza A and B were On hospital day 5 (illness day 11), the CCDC con- negative. Given the patient’s travel history and CT find- firmed that the oropharyngeal swabs of this patient ings, Hunan Province and Chinese Center for Disease tested positive for COVID-19 by real-time reverse Control and Prevention (CCDC) were immediately transcriptase-polymerase chain reaction (rRT-PCR) notified. CCDC staff required us to test the patient for assay. According to the suggestion of The Diagnosis and COVID-19, even though the patient disclosed that she Treatment of Pneumonitis with COVID-19 Infection had never been to the Huanan seafood market and (DTPI) published by the National Health Commission of reported no known contact with ill persons in the past the PRC, lopinavir and ritonavir tablets (2 pills BID by month. Specimens were collected following CCDC guid- mouth), which had been used to treat HIV infection in ance. After specimen collection, she was admitted to the the past, as well as interferon alfa-2b injection (5 million isolation ward of the First Hospital of Changsha City. IU added into 2 mL of sterile water, inhalation BID) On admission, the patient reported persistent dry cough, were added to the patient’s treatment regimen. On fatigue, headache, sore throat, and chest pain for a week. hospital day 8 (illness day 14), the temperature of this Upon physical examination, the patient was found to patient dropped to 36.4 °C. Moreover, her appetite im- have throat congestion without other remarkable proved, and she was asymptomatic apart from fatigue findings. and chest pain. A comparison of a new CT scan and the On hospital days 2–4 (illness days 8–10), the patient’s previous CT images showed that the bilateral patchy vital signs remained largely stable. She reported that her lesions in her lungs had been absorbed (Fig. 1c). Methyl- cough and sore throat were worse than before, accom- prednisolone sodium succinate was then discontinued. panied by chest pain and a small amount of sputum. On hospital day 9 (illness day 15), the blood pressure of Intermittent fever and sore throat were still reported this patient dropped to 85/55 mmHg. Therefore, Shen- (Fig. 2). Supportive treatment was performed at this mai injection 50 mg QD intravenously was used, and the stage, and methylprednisolone sodium succinate 40 mg patient’s blood pressure rose to 113/70 mmHg. On QD intravenously was given to inhibit lung inflamma- hospital day 10 (illness day 16), a negative result was ob- tion. During this period, we found that the patient devel- tained for the COVID-19 assay. This patient reported oped melena in the morning, indicating that we should that her cough and fever had abated and her clinical be aware of the possibility of upper gastrointestinal condition improved. Lopinavir and ritonavir were then bleeding. The patient was treated with pantoprazole for discontinued on hospital day 10 (illness day 16). Inter- acid suppression. Ambroxol (30 mg BID intravenously), feron alfa-2b injection and antibiotics were discontinued limonene, and pinene enteric soft capsules (0.3 g TID on hospital day 11 (illness day 17). On hospital day 14 peros) were used to expel sputum. Laboratory results on (illness day 20), this patient again tested negative for hospital days 1–3 (illness days 7–9) reflected leukopenia, COVID-19 by rRT-PCR assay, and was discharged on neutropenia, lymphopenia, and reduced hematocrit. January 30, 2020 (hospital day 15, illness day 21). Additionally, elevated levels of lactate dehydrogenase and C-reactive protein were observed (Table 1). Accord- Methods ing to the suggestion of The Diagnosis and Treatment of Diagnostic process Pneumonitis with COVID-19 Infection (DTPI) published In accordance with the DTPI guidelines, this case was by National Health Commission of the PRC, we gener- diagnosed based on epidemiological history and clinical ally monitor the patient’s blood oxygen saturation and manifestations: Zhou et al.