PMC8456079_01
Pulmonary sequelae of COVID-19. (A) SARS-Cov-2 nucleic acid test results; (B) Serial CT thorax images at different timepoints from initial presentation of symptoms, and the corresponding COVID-19 CT severity score; (C) Percentage of high attenuation area (HAA%) on CT imaging indicating pulmonary fibrosis; (D) Immunosuppressive therapy regime before, during and after the patient's hospitalization for severe COVID-19.
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A nasopharyngeal swab specimen obtained and SARS-CoV-2 ribonucleic acid (RNA) was detected using conventional qualitative reverse transcription polymerase chain reaction (Figure 1A). A computed tomography (CT) scan of the thorax demonstrated extensive ground glass opacity across the left lung field (Figures 1B, C), and routine blood tests revealed a lymphocytopenia. His normal 6mmunosuppression regime was re-established by 4-months after symptom onset (5 mug/L tacrolimus, 1 g/day MMF and 2.5 mg/day prednisone) (Figure 1D). The percentage of high attenuation area (HAA%) approached 0% at 1 month after onset and remained 0% at 1-year, suggesting no pulmonary fibrosis following the acute COVID-19 episode (Figures 1B, C). The serum levels of monocytes and NK (CD3-, CD56+) cells fluctuated, whilst NKT (CD3+, CD56+) levels increased throughout the follow-up period in the infected patient (Figure 3D, Supplementary Figure 1).
Changes in renal function related to COVID-19. (A) Serial serum creatinine and eGFR measurements; (B) Urine protein, micro total protein, micro albumin, and beta2 microglobulin measurements. (C) Urinary WBCs and urinary nitrite (NIT) measurements. The mean value derived from two uninfected paired controls is shown using dotted lines as a comparator.
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The patient's kidney function was transiently impaired shortly after onset of severe COVID-19 (Figures 2A, B). His urinary nitrite (NIT) levels always remained negative (Figure 2C).
Dynamic changes of cellular and humoral immunity after SARS-CoV-2 infection. (A) Serum RBCs and Hb measurements; (B) Serum WBCs, lymphocyte and neutrophil counts; (C) Serum lymphocytes and neutrophils proportions; (D) The proportion of immunocytes; (E) Cytokines levels; (F) B cell counts; (G) Antibodies against SARS-Cov-2. The mean value derived from two uninfected paired controls is shown using dotted lines as a comparator in (A-E).
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The patient's red blood cell count (RBC) and serum hemoglobin (Hb) stayed within normal range throughout the acute COVID-19 infection and follow-up period (Figure 3A). An elevated white blood cell (WBC) count, neutrophillia, and lymphocytopenia (Figures 3B, C) were identified at the onset of symptoms. At month 1, the levels of T cells, CD4+ T cells, CD8+ T cells, B cells and NK cells were lower compared with the controls, which could be explained by the cytolytic effect during the acute progressive phase of COVID-19 (Figures 3D-F). The serum levels of monocytes and NK (CD3-, CD56+) cells fluctuated, whilst NKT (CD3+, CD56+) levels increased throughout the follow-up period in the infected patient (Figure 3D, Supplementary Figure 1). Only the concentration of IL-2R rose again after month 7, but also remained at normal level (233-710U/mL) (Figure 3E). However, after this, it gradually increased to a slightly higher level than the controls (Figure 3F). The IgG antibody achieved its peak level at month and then decreased but still remained positive throughout the follow-up window (Figure 3G).