Abstract

Relevance. Patients with type 2 diabetes mellitus are at high risk of severe COVID-19, multiple organ failure, and death. Despite the introduction of direct-acting antiviral agents, including molnupiravir, some patients may still experience an unfavourable outcome despite early initiation of treatment, highlighting the need for further investigation.

Aim. To evaluate the course of COVID-19 in a patient with type 2 diabetes mellitus using a clinical case and to analyse the possible reasons for the  unfavourable outcome despite the timely administration of molnupiravir.

Materials and methods. A retrospective descriptive case study was conducted. The course of COVID-19 was analysed in a 56-year-old woman with type 2 diabetes mellitus who received antiviral therapy with molnupiravir from the fourth day of illness. Clinical manifestations, laboratory and instrumental findings, treatment characteristics, and the possible causes of the  unfavourable outcome were assessed.

Results. The illness began with moderately severe respiratory symptoms and a low-grade fever. On hospital admission, signs of decompensated diabetes mellitus were identified, including hyperglycaemia (14.7 mmol/L), ketonuria (3+). Also elevated C-reactive protein (CRP) level of 91.5 mg/L and lymphopenia were revealed. Although there were no clinical and radiological signs of pneumonia on admission, the patient’s condition deteriorated rapidly, with the development of metabolic acidosis, diabetic ketoacidotic coma, bilateral polysegmental pneumonia, acute respiratory distress syndrome, and multiple organ failure. Early administration of molnupiravir did not prevent a fatal outcome.

Conclusions. This clinical case demonstrates that, in patients with decompensated diabetes mellitus, COVID-19 may progress rapidly to a critical condition even in the absence of signs of pulmonary involvement at the  early period of the disease. One of the key factors contributing to the poor prognosis was likely metabolic decompensation associated with ketoacidosis and a systemic inflammatory response. COVID-19 vaccination did not prevent the fatal outcome in this patient. The effectiveness of antiviral therapy for COVID-19 depends not only on the timely initiation of treatment but also on the degree of control of underlying comorbidities and the early correction of metabolic disordes. The clinical effectiveness of molnupiravir may depend on the SARS-CoV-2 variant, the baseline viral load, and individual patient peculiarities. Specialised molecular genetic studies are required to assess the potential role of antiviral resistance.