Methylprednisolone/prednisolone

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 41-year-old man developed masking of COVID-19 infection followed by its reactivation, during treatment with methylprednisolone and prednisolone [routes not stated].

The man, who had dizziness, vomiting, headache and gait ataxia for 10 days, was admitted on 15 June 2020. His SARS-CoV-2 RT-PCR test returned to negative for COVID-19 infection. Owing to suspicion of a secondary demyelinating disease, he started receiving treatment with methylprednisolone 1 g/day for 3 days, followed by prednisolone 1 mg/kg/day. On 23 June 2020, his swab test for SARS-COV-2 infection returned positive. Then, he was transferred to a COVID-19 isolation area. He did not experience fever, respiratory or gastrointestinal symptoms during the hospital stay. However, on 29 June 2020 and 30 June 2020, his SARS-CoV-2 tests returned negative. Hence, he was considered to be cured from asymptomatic COVID-19. On 3 July 2020, he was discharged on prednisolone 80 mg/day. On 06 July 2020, a chest-CT scan showed subpleural focal ground-glass densification area in the right lateral basal segment, consistent with early COVID-19 infection. On 9 July 2020, he developed fever, headache, myalgia and cough. On 13 July 2020, he was tested as an outpatient for SARS-CoV-2, with a positive result. On 15 July 2020, he was re-admitted with worsening of COVID-19, with dyspnoea and thoracalgia.

Upon admission, the man was found to have tachypnoea and severe respiratory failure, requiring intubation. Thereafter, he was shifted to the ICU. Subsequent chest CT scan showed diffuse bilateral ground-glass opacification and extensive subpleural consolidation of the lower lobes. His SARS-CoV-2 RT-PCR test returned positive for COVID-19 infection. Hence, it was concluded that, he had developed masking of COVID-19 infection followed by its reactivation, due to the effect of methylprednisolone and prednisolone on viral shedding dynamics of COVID-19. He then started receiving treatment with remdesivir. Additionally, he received off-label methylprednisolone 80 mg/day (for 7 days followed by tapering), along with piperacillin/tazobactam. Following the treatment, his symptoms improved, and he was extubated after 7 days. At the time of report, he had been discharged from the ICU, and was progressing favorably in the COVID ward.