PMC6288977_01
CT findings at emergency department. Non-contrast CT scan was performed using slice thickness 5 mm. The picture shows ground-grass findings spreading in both lungs. Such infiltrative shadows spread diffusely from the apex of each lung to above the diaphragm.
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Both lungs showed a ground-glass appearance in the chest X-ray and computed tomography (CT) showed consolidation spreading in a mosaic pattern from the middle to distal side of both lungs (Fig. 1).
Sputum cytology on the first hospital day. The picture shows aggregation of eosinophils (arrows). The percentage of eosinophils increased slightly (14.7%). Many neutrophils were present (51.7%).
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The cytological findings showed that aggregated eosinophils were accumulating and the percentage of eosinophils, neutrophils, and lymphocytes were 14.7%, 51.7%, and 33.6%, respectively (Fig. 2). 1000mg of mPSL was administrated intravenously for three days, followed by 60mg of oral prednisolone.
Clinical course. On the first day, the patient had little tidal volume. ECMO was needed for four days and the tidal volume (blue bar) increased gradually with administration of methylprednisolone. Interestingly, although blood tests showed no eosinophils on the first day, the elevation of eosinophils (orange line) reached 2980/muL on the seventh day.
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Tidal volume started to increase on the fourth hospital day and oxygenation and carbon dioxide emission were gradually recovered (Fig. 3). Blood tests showed the number of eosinophils had increased from the fifth hospital day up to 2980/muL on the seventh day (Fig. 3).