A second real-time reverse transcriptase-polymerase chain reaction (PCR) test of the pharyngeal flora just after the first CT was positive for SARS-CoV-2 virus RNA. The patient received ERCP and biliary stent placement because of his biliary obstruction.

Subsequent real-time polymerase chain reaction (PCR) tests on days 12 and 15 were also positive.

This case illustrates a progressive course of COVID-19 pneumonia:

• two very small areas of ground-glass opacity initially
• diffuse involvement of more than 75% of all lobes in both lungs with a typical crazy paving pattern and extensive pulmonary consolidations twelve days after symptom onset

In the second CT, there are also bilateral pleural effusions and some mediastinal lymphadenopathy present, although this is rather atypical for COVID-19 pneumonia.