PMC7606860_01
The patient had rough, cracking skin on the tips and sides of the fingers ("mechanic's hand").
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He demonstrated evidence of "mechanic's hand" (roughening and cracking of the skin) (Fig. 1).
Chest CT images of the patient. (A) On admission to the first hospital (day 1), chest CT images showed consolidations and ground-glass opacities (GGO), predominantly in the bilateral lower lobes with loss of lung volume, suggesting a radiologic pattern of diffuse alveolar damage (DAD) superimposed on non-specific interstitial pneumonia (NSIP). (B) On admission to Hamanomachi Hospital (day 11), chest CT images showed progression of the areas of GGO, consolidations, traction bronchiectasis, and decreased lung volume. (C) On day 40, chest CT images showed improvement of GGO and consolidations. Traction bronchiectasis in the peripheral area and loss of lung volume were partially reversed as well.
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Chest computed tomography (CT) showed consolidations and ground-glass opacities (GGO), predominantly in the bilateral lower lobes with decreased lung volumes, suggesting a radiologic pattern of diffuse alveolar damage (DAD) imposed on non-specific interstitial pneumonia (NSIP) (Fig. 2A). Repeat chest CT showed a new development of mediastinal emphysema with worsening consolidation, GGO, traction bronchiectasis, and loss of lung volume, predominantly in the left lobes, suggesting progressive fibrosis (Fig. 2B). His chest CT, repeated on day 40, showed improvement of GGO and consolidations (Fig. 2C). Traction bronchieactasis in the peripheral area and lung volume was somewhat improved as well (Fig. 2C).
A clinical course of the case.. The patient was transferred to Hamanomachi Hospital on day 11.. mPSL: methylprednisolone, PSL: prednisolone, IVCY: intravenous cyclophosphamide, TAC: tacrolimus, rTM: recombinant thrombomodulin, IVIG: intravenous immunoglobulin, MEPM: meropenem, MINO: minocycline, LVFX: levofloxacin, ST: sulfamethoxazole-trimethoprim, CRP: C-reactive protein, LDH: lactate dehydrogenase, RM: reservoir mask, NHF: nasal high flow, FiO2: fraction of inspiratory oxygen.
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Due to suspicion of thrombotic microangiopathy in the pulmonary microvessels, based on his high levels of D-dimer, continuous intravenous dalteparin (5000 U/day) was started (Fig. 3).