Successful outcome of inhalation injury, active SARS-CoV-2 infection and concomitant pneumonia in a patient with 27% full thickness burn: a case report

Abstract

Burn injuries are a major cause of morbidity and mortality. Next to the inhalation injury, total body surface area and age are strong predictors of mortality in burn victims.

The novel coronavirus disease (COVID-19) pandemic is associated with a fatality rate of around 3,5%. We present a case of burn victim with full thickness burn to face, scalp, both upper extremities (27% of total body surface area), inhalation injury and active SARS-CoV-2 infection with concomitant pneumonia.

The inhalation injury in COVID-19 positive patient was severe. A bronchoscopy revealed a diffuse erythema of the trachea and both main bronchi, the whole bronchial tree up to the distal segments was covered with carbonaceous material which could not be removed. We decided to treat the inhalation injury according to the guidelines for burns and acute respiratory distress syndrome. Accordingly, the patient did not receive any antiviral drugs or corticosteroids.

The reconstruction of a full-thickness scalp defect after burn presents a challenge in large size defects and in patients with comorbidities. Double layer Integra Dermal Regeneration Template (Integra LifeSciences, Plainsboro, New Jersey) was the reconstruction method of choice. The take of dermal template and split thickness skin graft was 100% and good scalp contour was achieved.

To our knowledge this is the first case report presenting a successful treatment outcome in a burn victim with inhalation injury, active SARS-CoV-2 infection and concomitant pneumonia with full thickness burn of 27% of total body surface area.