PMC7115736_01
Serial chest radiograph: (A) on initial presentation; (B) 8 days after initial presentation, immediately before the first admission to intensive care unit; (C) 5 weeks after initial presentation, showing persistent bilateral pulmonary infiltrate despite ribavirin and corticosteroid; and (D) 8 weeks after initial presentation, showing slowly resolving pulmonary infiltrate.
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FIG1
Chest radiograph on admission showed right lower lobe consolidation (Fig 1A). A repeat chest radiograph showed bilateral pulmonary infiltrate (Fig 1B). In view of the protracted disease course and lack of radiographic improvement with ribavirin and corticosteroid (Fig 1C), he was further treated with 200 mL of convalescence plasma from a recovered SARS patient, and 5 mL/kg IgM-enriched human immunoglobulin (Pentaglobulin; Biotest, Dreieich, Germany) for 3 days on day 38 of his illness. Chest radiograph improved slowly and continued to show bilateral basal infiltrate 8 weeks after the initial presentation (Fig 1D).
Fluctuation of body temperature. Bold letters along the X-axis indicate the time at which the corresponding chest radiograph in Fig 1 was performed. Note the temporal relationship between fever, radiographic change, and treatments given. Virology results including serology and stool specimen for coronavirus isolation are also shown.
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FIG2
The subsequent clinical course and treatment are summarized in Fig 2. PCR for RNA of SARS-associated coronavirus in the stool specimen performed on day 53 was still positive, and then 3 consecutive stool specimens were negative for viral culture starting from day 64 to day 75 (Fig 2).
High resolution computed tomography of thorax 8 weeks after initial presentation. There is diffuse ground glass opacification, bilateral patchy consolidation, and fibrosis, features compatible with recovery phase of ARDS.
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FIG3
A high-resolution computed tomography of thorax showed diffuse ground glass opacification, bilateral patchy consolidation, and fibrosis, features compatible with recovery phase of acute respiratory distress syndrome (ARDS) (Fig 3).
Time course of hemoglobin values and transfusions. Each triangle represents a unit of packed cell transfused. To convert hemoglobin in g/dL to g/L, multiply by 10.
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FIG4
He received transfusions of a total of 20 U during his admission for about 3 months, compared to 10 U in the preceding 6 months (Fig 4). 