A 28-year-old pregnant woman who worked as a nursing assistant, was a primigravida with 31 weeks of gestation age who sought the emergency unit with fever and hyperemic lesions in the right lower limb, suggestive of a bacterial skin infection. The patient did not smoke or report a prior history of asthma, tuberculosis or pneumonia. Treatment was initiated with intravenous ceftriaxone (2 g) associated with 40 IU per day of heparin, though after two days, the patient began to exhibit acute dyspnea. The room oxygen saturation was found to be 95%, and symptoms were accompanied by tachypnea and hypotension. Fifteen liters of oxygen per minute were provided by mask, and the patient was transferred to the intensive care unit (ICU) of another public institution. She was admitted in critical conditions requiring urgent intubation and mechanical ventilation. The lactate dehydrogenase (LDH) was 268 U/L, D-dimer less than 300 ng/mL (normal values below 500 ng/mL) and 3,900 white blood cells (WBC). Computed tomography (CT) scans revealed bilateral patchy ground glass opacities, and the patient was considered as a suspicious case of SARS-CoV-2 infection. Considering the CT findings and the severe evolution in the third trimester of gestation, she was medicated with 500 mg azithromycin per day, 75 mg oseltamivir phosphate twice a day and 400 mg hydroxychloroquine twice a day for five days, in addition to the ventilation support. Pulmonary embolism was excluded by using specific diagnostic tests.
She tested negative for coronavirus by the real-time reverse transcription polymerase chain reaction (RT-PCR) testing nasopharyngeal secretions swabs during the initial hospitalization. Owing to the severe clinical conditions, a cesarean section (C-section) was performed. A healthy 31-week gestational age infant, weighting 2,380 g, was delivered and transferred to the neonatal care unit because of the prematurity, the Apgar score was 8 on the 1st minute of life and 9 on the 5th minute and the preterm newborn was adequate for gestation age. The puerperal woman remained hospitalized for 18 days in the intensive care unit (ICU) due to her respiratory conditions, receiving supportive care. The patient tested positive for COVID-19 by RT-PCR on the 12th day after hospitalization. The newborn tested negative for COVID-19 by RT-PCR and was released after 5 days. The puerperal woman evolved favorably and was discharged without sequelae after 23 days.