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Sigman S.A. et al.: A 57-year-old African American man with severe COVID-19 pneumonia... © Am J Case Rep, 2020; 21: e926779 Figure 3. Radiographic Assessment of Lung Edema (RALE) by CXR showed reduced ground-glass opacities and consolidation following PBMT. Lung radiographic score is dependent on extent of involvement based on consolidation or ground-glass opacities for each lung. Total score is the sum of both lungs. Scores classification: 0 – no involvement; 1 – <25% of lung involved; 2 – 25–50% of lung involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved. RALE score before laser therapy (04-27-2020)=8. Laser therapy started on (04-29-2020). RALE score after laser therapy (05-03-2020)=5. Human trials have shown local and systemic effects of PBMT when applied to quadriceps muscle in patients with chron- ic obstructive pulmonary disease [10]. Beneficial effects ex- tended beyond improved muscular performance, to statisti- cally significant reductions in dyspnea and fatigue [10]. Our patient also reported subjective feelings of improved respira- tory function and strength. Our patient was only placed in the prone position for the du- ration of laser treatment. Treatments lasted exactly 28 min for each of the 4 days. Physiological evidence and clinical tri- al data support the use of prone position ventilation in se- lected patients with moderate-to-severe ARDS. For patients to benefit, the use of long prone positioning sessions of 12 h to 18 h per session are necessary [34,35]. An increase in SpO2 from 94% to 100% occurred within the first 5 min of treat- ment, and the patient maintained good saturation thereaf- ter. This finding shows the rapid effect of PBMT treatment on oxygen saturation. It is unlikely that prone positioning alone was the reason for improved oxygenation, given the minimal time in that position. A strength of this case report is that we collected patient symp- tom data before and after treatment. All 4 pulmonary scor- ing tools and the 3 patient questionnaires demonstrated the benefit of treatment. To the best of our knowledge, this was the first time that PBMT was used as adjunctive treatment for pneumonia in a COVID-19 patient. Irradiation over the posteri- or projection of the lungs, using the scanning method, has no risk of contamination since the scanning laser does not phys- ically touch the patient. A deficiency of our study is the lack of inflammatory markers and blood tests. Future studies should include measurements before and after treatment of interleu- kin-6, interleukin-10, TNF-a, as well as additional inflammatory markers. A limitation of this case report is that this is a single patient and we were unable to carry out any statistical analysis. Conclusions This report has presented a patient with severe COVID-19 pneu- monia associated with ARDS who was given supportive treat- ment with PBMT. Based on this case report, as well as clinical experience of PBMT in respiratory tract diseases in humans, we consider PBMT to be a feasible adjunct modality for the treatment of COVID-19. There is published experimental work demonstrating the anti-inflammatory effect of PBMT on lung tissue. We suggest that the use of adjunct PBMT in the early stages of severe ARDS seen in COVID-19 patients can enhance healing and reduce the need for prolonged ventilator support and ICU stay. The urgent current medical situation calls for PMBT pilot studies and clinical trials to evaluate its effect on COVID-19 pneumonia. This patient is part of an ongoing in- vestigational randomized controlled trial. This work is licensed under Creative Common Attribution- NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) 6 Indexed in: [PMC] [PubMed] [Emerging Sources Citation Index (ESCI)] [Web of Science by Clarivate] APPROVED GALLEY PROOFPDF Image | A COVID-19 Pneumonia Responded to Photobiomodulation Therapy
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