A 54-year-old male who is a known hypertensive compliant on medications, was admitted at the HIIU as a case of COVID-19 pneumonia (positive SARS-CoV-2 polymerase chain reaction analysis on a nasopharyngeal swab sample). He had a 3-week history of fever, cough productive of yellowish, non-bloody sputum and pleuritic chest pain. He also had a week s history of progressively worsening breathlessness. There was associated sore throat, headache and myalgia. He had no contact with a confirmed COVID-19 patient. Initial chest computer tomography (CT) scan at the onset of symptoms showed features suggestive of mild COVID-19 pneumonia. At presentation his symptoms had worsened. His temperature was 36.4 C, pulse rate was 58 beats/min, respiratory rate 30cycles/min, blood pressure 145/96mmHg and oxygen saturation (SpO2) 93% on oxygen delivered via non-renon-rebreather mask at 15Liters/min. His full blood count showed leukocytosis with neutrophilia (Table 1). Sinus bradycardia and a corrected QT interval (QTc) of 0.446s was seen on initial ECG with a repeat QTc on completion of hydroxychloroquine being 0.426s. Cultures for blood and urine were negative. Sputum gene Xpert was negative for Mycobacterium tuberculosis. He was initiated on empiric intravenous ceftriaxone 2g twice daily for 72 hours, intravenous dexamethasone 6mg daily for 10 days and subcutaneous enoxaparin 80mg twice daily. He was also given oral hydroxychloroquine 200mg three times daily for 10 days, oral azithromycin 500mg stat, then 250mg daily x 4; zinc 20mg daily (according to Ghana s Standard Treatment Guidelines for COVID-19) oral zinc 20mg daily x 21 and oral multivitamins 1 daily x 30. On day 7 of admission, 15 days after the initial chest CT scan was taken, his symptoms had worsened further with marked breathlessness on minimal exertion and easy fatiguability. His respiratory rate was 40 cycles/min. SpO2on oxygen given via non-rebreather mask at 15L/min was 94% and 85% in room air. CT pulmonary angiogram (CTPA) was requested due to suspicion of pulmonary embolism. It showed severe worsening of bilateral consolidation and ground glass densities with fibrotic changes in the lung bases on both sides. There was no evidence of pulmonary embolism (Figure 1). On day 11 of admission, his C-reactive protein (CRP) came out as 80.59mg/L (Table 1). A single dose of 400mg of tocilizumab reconstituted with 80mls of 0.9% of normal saline solution was administered via a perfuser over 60 minutes on day 12; on account of deteriorating respiratory symptoms, hypoxia, an elevated CRP (all indicators of CRS) and worsening chest CT scan findings. His respiratory symptoms gradually improved. CRP done on day 15 was 4.57mg/L and a repeat chest CTPA done on day 16 showed marked improvement with significant loosening of the bilateral consolidations and improvement in bilateral ground glass densities (Figure 2). There was however a bilateral base of fibrotic changes for which oral pirfenidone was initiated for 3 weeks. His lymphocyte count also increased from 2.06 x103/microliter to 2.78 x103/microliter. On day 21 of admission he was weaned off oxygen. His SpO2in room air was 96%. He was discharged on day 23 for review at the outpatient clinic and is presently doing very well clinically.