PathoBiocheModel of the double-edged sword of glucocorticoids: a case report of COVID-19 management of an outpatient with sarcoidosis

Background: For coronavirus disease 2019 (COVID-19), glucocorticoids are accepted treatment against its attendant inflammation. However, their use has side effects raising the possibility that they may be harmful in its management. Following the principle of primum non nocere, we used biochemical pathways to model a complicated patient’s condition to predict this eventuality. Case Description: We present the case of a 60-year-old man with progressive sarcoidosis who was receiving glucocorticoids and contracted COVID-19. He was admitted to a hospital, stabilized, discharged and then worsened. He declined re-admission and was managed at home by family members under the tele-supervision of an intensivist. To individualize management, we modelled his biochemical pathogenesis graphically in the form of a PathoBiocheModel, emphasizing the roles of glucose-6-phosphate dehydrogenase (G6PD) and triiodothyronine (T₃). It was developed using his personal data—clinical course and laboratory biomarkers—and published data that was extracted and integrated by sci.AI machine reasoning methods. Based on the PathoBiocheModel—which was validated by the group of our authors— we recognized an underlying insulin resistance which affected the patient’s G6PD status, and therapeutic interventions were modified. The patient successfully recovered. Inspired by his good outcome, we discuss our insights, using biochemical rationale, on the benefits and risks of glucocorticoid use in COVID-19. Conclusions: While glucocorticoids are used for COVID-19, in our case report we demonstrated that they were harmful. They aggravated an underlying insulin resistance and G6PD deficiency, as a consequence, that potentiates COVID-19. And, interestingly, this was reflected by T₃ levels used as a biomarker.