PMC6831859_01
Chest X-rays in case 1. Chest X-ray on admission (A) showed consolidation and reduced volume of the right lung. The greatest deterioration had occurred on day 8 (B), and by the time of discharge on day 18, they had improved but were still somewhat present (C). The reduced volume of the right lung has remained after two years (D).
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Chest X-ray showed consolidation and reduced volume of the right lung (Fig. 1-A). CAP and started antibiotics (ampicillin/sulbactam + clarithromycin). Consolidation and volume reduction of the right lung continued to deteriorate, reaching a peak on the 8th day of hospitalization, but they gradually improved (Fig. 1-B, C). Pneumonia has not recurred as of 2 years after discharge, but the reduced volume of the right lung has remained (Fig. 1-D).
Chest computed tomography (CT) in case 1. Chest CT on admission showed bilateral consolidation (right dominant), ground-glass opacities (GGOs) around the consolidation, and air-bronchogram accompanying traction bronchiectasis within the consolidation. The GGOs in part showed non-segmental distribution.
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Computed tomography (CT) (Fig. 2) on admission showed bilateral consolidation (right dominant), ground-glass opacities (GGOs) around the consolidations, and air-bronchogram accompanying traction bronchiectasis within the consolidations.
PMC6831859_02
Chest X-rays in case 2. Chest X-ray on admission (A) showed nodular consolidation on both sides of the lung that had almost resolved at day 8 (B).
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Chest X-ray (Fig. 3-A) showed nodular consolidation on both sides of the lungs. A follow-up chest X-ray (Fig. 3-B) was clear, and he was discharged on the 10th hospital day with no complications.
Chest computed tomography (CT) in case 2. Chest CT on admission showed patchy consolidation and GGOs along the bronchial vascular bundle in the upper and lower lobes of the left lung and upper segment of the right lower lobe. Traction bronchiectasis and volume reduction of the lungs were not observed.
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Chest CT (Fig. 4) on admission showed patchy consolidation and GGOs along the bronchial vascular bundle in the upper and lower lobes of left lung and S6 of the right lung.
Histologic findings. Histologic findings from transbronchial lung biopsy in case 2 showed organization, swollen pneumocytes, and alveolar septal thickening with inflammatory cells (hematoxylin and eosin staining; magnification, x 50).
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BAL fluid was 2.1 x 105 cells/mL, including 80.8% macrophages, 12.7% lymphocytes (CD4/CD8 ratio, 10.6), 4.9% eosinophils, and 1.6% neutrophils. BAL fluid yielded no bacteria, but transbronchial lung biopsy revealed organization, swollen pneumocytes, and alveolar septal thickening with inflammatory cells (Fig. 5).