A case of coronavirus disease 2019 in a pregnant woman successfully treated with shoseiryuto: A telephone consultation

Abstract

Dear Editor The number of coronavirus disease2019 (COVID-19) cases in Japan has reached 21 million and is rising; the COVID-19 epidemic is continuing with exacerbations and remissions. The surge in COVID-19 cases will put a strain on hospitals across the country; we estimate that approximately 0.5% of all infections may occur during pregnancy. All infection during late pregnancy increases the probability of preterm delivery and may cause severe illness [1]. Oral drugs, like molnupiravir, cannot be prescribed because of their teratogenic potential [2], and drugs reducing the disease severity in pregnant women are limited. Kampo medicines are effective, relatively inexpensive, and safe for incident viral infections, but only a few cases of Kampo medicines used to treat pregnant women have been reported [3]. We experienced a case of COVID-19 with persistent symptoms, including cough in a pregnant woman. A primiparous woman developed COVID-19 at 30 weeks and one day of gestation and opted for home care. Her, cohabiting husband and two-year-old son had COVID-19 ten and six days respectively before her illness set in. Because of persistent cough and phlegm that disturbed her sleep at night, she made a request for a telephone consultation from our clinic through the Akita City Public Health Center. We prescribed shoseiryuto (SST) (a Tsumura medical extract), 7.5 g/d for fivevdays. After treatment, her cough and sputum were alleviated almost fully (Table 1), and management of her remaining condition was transferred to the hospital at which she was scheduled for delivery. We referred to the manuals of acute contagious diseases, Shanghanlun [4] and Jin Gui Yao Lue [5], written in China in the third century, to select the best Kampo medicine for our patient. SST is used in the early yang stage of the medium pattern to treat wheezing, cough, dyspnea, and nasal symptoms. Jin Gui Yao Lue [5] mentions “Cough rises up and you cannot lie on your back to breathe.” In that case, the patient could not lie down owing to persistent coughing, and the doctor suggested SST treatment. This is congruent with the present case of “persistent cough and phlegm during the night and inability to sleep.” Moreover, the Shanghanlun [4] mentions, “In case of cold damage (acute contagious diseases such as COVID-19 in the present case), and if the exterior has not healed, there is water qi below the heart, dry retching, heat effusion and cough, possibly thirst or diarrhea or dysphagia, inhibited urination and lesser abdominal fullness, or panting, then use SST.” We believed this can be applied to the present case owing to “the symptoms of fever, cough, phlegm, and runny nose that persisted even on the fifth day after disease onset, and the distended stomach.” Based on these manuals — Shanghanlun and Jin Gui Yao Lue — the patient was prescribed SST. The patient experienced no adverse events including side effects. However, additional studies on pregnant women treated with SST are necessary. Finally, we are currently conducting a study on the use of SST for COVID-19 cases in pregnant women, including this case, with the approval of the Ethics Committee of Akita Medical Association (No. 44, 2022.8.15), and will soon report on the results of the study.