Hyperpyrexia and metabolic alkalosis in a COVID‐19 patient

To the Editor,

Suwanwongse et al ¹ suggest that coronavirus disease 2019 (COVID‐19) patients who present with hyperpyrexia are usually 50 to 60 years old. I am submitting a brief case report which advances the medical community's knowledge regarding this topic.

A 20‐year‐old girl with a past medical history of bronchial asthma was admitted at a healthcare facility in Mauritius with a 3‐day history of high‐grade fever, cough, and shortness of breath. On arrival, her oxygen saturation was 75% on room air, temperature was 42°C and respiratory rate was 35 per minute. Chest X‐ray showed bilateral pulmonary infiltrates and a polymerase chain reaction test on a throat swab for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was positive.

An arterial blood gas (ABG) on day 2 of admission revealed a mild respiratory acidosis with a pH of 7.30, pCO₂ of 52 mm Hg, and a PaO₂ of 34 mm Hg while on a nonrebreather mask with oxygen flowing at 15 L per minute. Thereafter, she was intubated. Her temperature varied from 42°C to 44°C.

On day 4 of her admission, a repeat ABG showed metabolic alkalosis with a pH of 7.55, pCO₂ of 45 mm Hg, and a bicarbonate level of 38 mEq/L. Urea, creatinine, potassium, and sodium levels were within normal range. She was treated with chloroquine, clarithromycin, normal saline, meropenem, methylprednisolone, paracetamol, and nebulized salbutamol with ipratropium. Unfortunately, she passed away on day 7.

Among intubated patients, posthypercapneic metabolic alkalosis is often seen in the presence of chronic ventilatory defects like chronic obstructive pulmonary disease, obesity hypoventilation syndrome, cystic fibrosis, scoliosis, or amyotrophic lateral sclerosis. However, this patient did not have such diseases; moreover, she was a nonsmoker. She was believed to have a contraction alkalosis with loss of chloride ions because of dehydration due to an excessively elevated body temperature.

Jeong et al ² published a case report about a 58‐year‐old woman with COVID‐19 who presented with hyperpyrexia and recovered from a possible cytokine storm. Soh et al ³ describe high‐grade fever with temperature above 40°C (without hyperpyrexia) in two COVID‐19 patients who were treated with favipiravir and who developed neuroleptic malignant syndrome.

This is the first case report to confirm that hyperpyrexia can be seen in young adults infected by the SARS‐CoV‐2 virus.

KEYWORDS

epidemiology, pandemics, pathogenesis, respiratory tract, SARS coronavirus, virus classification