COVID-19 pneumonia - rapidly progressive

Case contributed by Andrea Manrique Gil
Diagnosis certain


Brought to the ER due to general discomfort, dysthermic sensation although without fever, dizziness for 1 week, and associating bilious vomiting today. No cough, although he complained of dyspnea. No contact with positive COVID-19 patients or recent trips outside Spain. Previously in the same month, he attended the ER concerning a foot ulcer.

Patient Data

Age: 80 years
Gender: Male

Baseline XR 1 wk preadmission


No significant findings.

Day 1 of admission


Poorly defined opacities in both lungs, predominantly in the lower lobes, peripherally located and some of them coming together to form consolidations.

Day 3 of admission


Radiological worsening due to greater density and extension of the ground glass opacities with a prominent peripheral and basal distribution within a multilobar involvement.

Day 6 of admission


Bilateral alveolar consolidation with panlobar changes, with typical radiological findings of ARDS. 

Case Discussion

The patient remained in the intensive care unit since his admission at the hospital with an unfavorable clinical evolution. It showed a significant elevation of acute phase reactants and lymphopenia. Likewise, the patient was found to be hypoxemic with decreased oxygen saturation. Real-time polymerase chain reaction (PCR) after pharyngeal swab was positive for SARS-CoV-2 virus RNA. The patient died a day after the last x-ray.

COVID-19 is a recent viral pandemic with a high incidence and variety of clinical manifestations, affecting multiple organs and systems, the most significant being the lung involvement, which has led to thousands of infections worldwide with a striking mortality rate.

It can lead to rapidly progressive ARDS, as shown in this case. The prognosis is poor and radiologic findings can go from ill-defined alveolar consolidations to bilateral consolidations with panlobar changes as seen in ARDS.

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