PMC7094230_01
Chronologic series of events leading up to the coronavirus pneumonia. At the time points indicated (circles), the absolute Dlco, corrected for hemoglobin concentration, was measured. The patient's predicted Dlco is shown by a dashed line. The four cycles of adjuvant chemotherapy are indicated by CAF and occurred at days -132, -103, -75, and -47. XRT = external radiation therapy; HDC = high-dose chemotherapy.
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She received four cycles of CAF (cyclophosphamide, 600 mg/m2 on day 1, doxorubicin, 60 mg/m2 on day 1, and fluorouracil, 600 mg/m2 on days 1 and 8) given every 28 days (Fig 1 ) that was followed by high-dose CPA/CDDP/BCNU (cyclophosphamide [1,875 mg/m2], given IV over 1 h each of three consecutive days (day -6, -5, -4), cisplatin [55 mg/m2] given by continuous infusion over 24 h each day for days -6, -5, and -4, and BCNU [600 mg/m2] infused over 2 h on day -3). Pco 2 of 36 mm Hg, Po 2of 89 mm Hg, and O2 saturation of 98%. Pulmonary function testing at this time showed that her Dlco had fallen 54% from her baseline level (Fig 1). RSV, parainfluenza A, B, and C, adenovirus, and influenza A and B. Results of pulmonary function testing were unchanged from 13 days previously (Fig 1). A follow-up visit at post-BMT day 220 showed her Dlco to be decreased approximately 21% from her prehospitalization value (Fig 1).
Top: a portable chest radiograph was performed on hospital day 4, demonstrating new, bilateral airspace opacities. Bottom: a chest CT radiograph on hospital day 5, demonstrating bilateral airspace disease and small left pleural effusion.
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A portable chest radiograph and chest CT scan demonstrated bilateral, predominantly lower lobe air space opacities (Fig 2 ).
EMs obtained from bilateral lower lobe bronchoalveolar fluid revealing numerous pleomorphic (but mostly spherical) virions. Club-shaped surface projections that are distinctive for coronavirus, can be seen (arrows). Bar = 100 nm.
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Electron microscopy (EM) of the BAL fluid demonstrated numerous viral particles with features that were diagnostic of coronavirus (Fig 3 ).