PMC7475736_01
Radiological findings in the patient. (a) Transverse chest CT images on days 1, 4, and 39. Bilateral infiltrative shadows and ground-glass lesions were apparent, which deteriorated on day 4. On day 39, ground-glass lesions decreased and lung aeration improved. (b) Chest radiographs showing changes in lung opacity over time. An endotracheal tube and blood delivery cannulas for ECMO are visible in the image taken on day 7. These were removed, and a tracheostomy tube is visible in the image taken on day 37.
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Computed tomography (CT) scan and chest radiographs showed bilateral, subpleural ground-glass opacities in both lungs (Figure 1). CT scan clearly showed exacerbation of the pulmonary pathology compared to the previous scan, with infiltration and reticular shadows appearing in wide areas of both lung fields (Figure 1).
Clinical course of treatment. The viral load peaked on the 19th day during the administration of remdesivir and then started to decrease. Red and blue circles indicate positive and negative results on PCR assay, respectively. LR, lopinavir/ritonavir; CLQ, chloroquine; ECMO, extracorporeal membrane oxygenation; PCR, polymerase chain reaction.
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Oral administration of lopinavir/ritonavir, an anti-human immunodeficiency virus (HIV) drug, and ceftriaxone were commenced.  Figure 2 illustrates the course of use of therapeutic drugs and medical devices. However, even after five days of favipiravir treatment in this case, PCR assay using sputum collected from the lower respiratory tract continued to show a positive result (Figure 2, Table S2). Ultimately, we confirmed a negative PCR result 41 and 43 days after the first positive result (Figure 2; Table S2) and weaned the patient off mechanical ventilation.