PMC7484740_01
CT scans (coronal, axial) of the chest (A) after diagnosis of EGPA, unremarkable for pulmonary disease manifestation, (B) showing ground glass opacities and interlobular septal thickening after diagnosis of alveolar hemorrhage by bronchoalveolar lavage, (C) demonstrating bipulmonary ground glass opacities and consolidations with minor reticulation. Presence of reversed halo sign (arrow) as previously described in COVID-19 pneumonia.
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F1
Immunoglobulin E (IgE) and C-reactive protein (CRP) were increased, ANCA-testing was negative, and a pulmonary CT scan unremarkable (Figure 1A). Immediately initiated immunosuppression with intravenous high-dose prednisolone and cyclophosphamide showed adequate therapeutic response. With conversion to oral glucocorticoid treatment at the end of January 2020, the patient unexpectedly developed a serious relapse of disease with peripheral neuropathy, pulmonary hemorrhage (Figure 1B) and a second myocardial infarction. Despite rhonchi/crackles on auscultation and a CT scan consistent with bilateral viral pneumonia (Figure 1C), the patient only reported mild dyspnea.
(A) Timeline of SARS-CoV-2 real-time reverse transcription PCR results (copy numbers) and numbers of immune cells during COVID-19. Colored bars indicate treatment regimen employed pre and post SARS-CoV-2 infection. (B) Course of COVID-19 induced inflammation markers quantified in patient sera including CRP, IL-6, procalcitonin (PCT), and body temperature ( C). Colored lines indicate patient symptoms related to SARS-CoV-2 infection. Vertical dashed line indicates onset of COVID-19 related symptoms.
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F2
A SARS-CoV-2 real-time reverse transcription PCR (rt-PCR) from oropharyngeal swab was positive (Figure 2A). With spiking serum concentrations of CRP (125.9 mg/L, reference range <5 mg/L), procalcitonin (0.56 ng/mL, reference range <0.05 ng/mL), and interleukin-6 (IL-6, 320 pg/mL, reference range <7 pg/mL), concomitant with decreasing CD4+ and CD8+ T-cell counts, the patient developed fever (max. 39.1 C) on day 7 (Figure 2B).