PMC6831833_01
Chest radiograph and computed tomography scan showing bilateral patchy ground-glass opacities, infiltrative shadows, and pleural fluid.
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Chest radiography showed ground-glass opacities in both lung fields (Fig. 1). High-resolution computed tomography (HRCT) demonstrated bilateral patchy ground-glass opacities, infiltrative shadows, and pleural fluid (Fig. 1).
Clinical course and treatments (AZM: azithromycin, CTRX: ceftriaxone, CyA: cyclosporine, IVIG: intravenous immunoglobulin, mPSL: methylprednisolone, PSL: prednisolone, TPE: therapeutic plasma exchange).
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The patient's clinical course is shown in Fig. 2.
Computed tomography scans obtained during the treatment. On Day 10, the scan shows deterioration after therapeutic plasma exchange. On Day 17, after 5 days of intravenous immunoglobulin therapy, there is improvement. On Day 69, after the patient had been discharged, the interstitial shadows have almost disappeared. From Day 346, the dose of prednisolone could be tapered.
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However, on the 10th hospital day, his respiratory condition had worsened; FiO2 had again increased from 0.30 to 0.35, and the bilateral patchy ground-glass opacities and infiltrative shadows on HRCT had worsened (Fig. 3). After initiating IVIG therapy, his respiratory function and the bilateral patchy ground-glass opacities and infiltrative shadows on HRCT began to improve (Fig. 3); he was therefore switched from NHF to nasal cannula two days after starting IVIG therapy. The changes observed in the interstitial shadows on HRCT are shown in Fig. 3.