PMC5348458_01
The patient's chest X-ray findings throughout hospitalization. On admission, no lung pathologies were observed (a). During hospitalization, the patient developed septic shock and ARDS, and bilateral interstitial pneumonia (mainly in the right middle-basal and left parahilar regions) was found. CVC is visible along the projection of the left subclavian vein (arrow) (b). The lung condition quickly worsened after admission to the ICU, with findings of bilateral diffuse interstitial-alveolar consolidations and no evidence of ventilation (c). Following the initiation of combination therapies, the lung picture partially improved, and bilateral ventilation resumed (d). After extubation, accentuated hilar and perihilar vascular images and reduced transparency due to interstitial-alveolar consolidations, mainly in the right lung, were observed (e). Over the following days, the lung picture markedly improved, with persistence of only minor alveolar consolidations at the middle right site and stasis of the small pulmonary circulation (f). ARDS: acute respiratory distress syndrome, CVC: central venous catheter, ICU: intensive care unit
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The findings from an X-ray examination of the chest (Fig. 1a), pelvis, and facial bones proved unremarkable. An urgent chest X-ray examination showed bilateral interstitial pneumonia (Fig. 1b), and urgent laboratory testing revealed markedly increased CRP levels (30.9 mg/dL) and procalcitonin levels (17.1 ng/mL), increased creatinine levels (2.4 mg/dL), and reduced Hb levels (7.6 g/dL) (Table). A further chest X-ray examination revealed a worse picture than that seen 2 days earlier, showing bilateral diffuse interstitial-alveolar consolidations with no evidence of ventilation (Fig. 1c). Hb levels, negativization of blood cultures) (Table), and chest X-ray findings (Fig. 1d) slowly improved. However, several attempts to wean her off sedation proved ineffective, owing to psychomotor agitation and subsequent desaturation; on one occasion, generalized seizure occurred after the withdrawal of sedation, and intravenous levetiracetam and intramuscular phenobarbital were started. Although reduced, interstitial-alveolar consolidations persisted on chest X-ray (Fig. 1e). The chest X-ray findings markedly improved, showing only small right alveolar consolidations (Fig. 1f).
The patient's basal CT of the brain showing cerebral atrophy and cerebrovascular disease. CT: computed tomography
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However, over several days, the patient developed acute urinary retention with marked bladder overdistension (1,700 mL), for which she was catheterised, and an acute confusional state requiring urgent computed tomography (CT) of the brain, which showed cerebral atrophy and cerebrovascular disease (Fig. 2).