PMC10265330_01
On hospital day 1, a chest X-ray revealed bilateral patchy shadows.
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The chest X-ray on admission exhibited patchy shadows in both lung fields (Figure 1).
Antimicrobials course before and during the patient's ICU stay.
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He was thus empirically treated with cefoperazone and levofloxacin (Figure 2). Ganciclovir and oral trimethoprim/sulfamethoxazole (240 mg/1.2 g q6 h) were administered to cover viruses, bacteria and P. jirovecii (Figure 2). P. jirovecii. Piperacillin + tazobactam, moxifloxacin, and ganciclovir were concurrently administered to cover possible bacterial and viral infections (Figure 2). Since gastrointestinal dysfunction could impair the absorption of oral TMP/SMX and decrease the plasma drug concentration, the patient was switched to intravenous TMP/SMX, supplemented with clindamycin (0.6 g q8 h) (Figure 2).
Chest CT scan on day 8 revealed diffuse stripe-like and ground-glass high-density shadows with honeycomb structures in both lung fields.
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In addition, the chest CT showed multiple ground glass opacities (GGOs) in both lungs (Figure 3).
Chest X-rays on day 11 showed bilateral diffuse ground glass-like opacities with honeycomb changes. The abdominal radiograph revealed dilated bowel loops.
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However, repeated chest X-ray findings showed no significant improvement but dilated bowel loops (Figure 4).
Repeated chest CT on hospital day 15 showed diminished patchy, grid-like, strip-like shadows in both lungs, compared to CT findings on day 8 (Figure 3).
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With an improvement of the patient's respiratory condition and resorption of pulmonary infiltrates on the repeat chest CT (Figure 5), clindamycin and caspofungin were discontinued after 7 and 10 days of use, respectively, to avoid potential side effects.
Chest X-rays showed haziness and increased vascular markings. The ground-glass opacities gradually decreased, although some opacities remained in the apical parts.
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Department, where TMP/SMX was prescribed for another 3 weeks. During that period, the patient had no fever or dyspnea, with the ground-glass opacities disappearing on chest X-rays (Figure 6).