Obesity in COVID-19 at young age-a case report

Background: Obesity has been a common factor in COVID-19 young patients who arrive at the hospital with advanced disease and high probability of invasive mechanical ventilation. The incidence of ARDS is increased in obese patients, although there are no studies that mention the association between the COVID-19 ventilatory phenotypes and obesity. These are two critical conditions that probably determine a hyper-inflammatory and hypercoagulable state. A correct ventilation and anticoagulation approach seems to be beneficial in these patients. Case: 32-year-old male, obese, with SARS-CoV-2 pneumonia. Clinically, with fever and cough and posterior respiratory failure, was hospitalized with severe disease, having bad prognosis markers, lymphopenia and negative septic screening. Admitted to the intensive care unit, needed invasive ventilation, with a “High-ARDS like” ventilatory phenotype. After unfavorable clinical evolution due to multiorgan dysfunction, antibiotic therapy was escaleted to cover nosocomial agents and low molecular weight heparin was adjusted. There was improvement of inflammatory parameters and ventilatory dysfunction since day tenth, was extubated at day fifteen and discharged after 22 days of hospitalization. Discussion: Obesity in COVID-19 seems a crucial factor, especially in young patients. COVID-19 infection may trigger a cytokine storm superimposed in a chronic hyper-inflammatory state as obesity. The patient presented with a “High-ARDS-like”. The relationship between COVID-19-obesity-ARDSLike phenotype can be suspected. Time to heal and anticoagulation with organ support until recovery (inflammatory-phase) could have been essential for the patient improvement. Conclusion: Obesity seems to be a crucial risk factor, especially in young patients. Anticoagulation with organ support until recovery of the inflammatory phase proved to be essential for the patient recovery.