COVID-19 pneumonia - rapidly progressive

Case contributed by Dr Andrea Manrique Gil

Presentation

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
X-ray

Baseline x-ray - 1 week before admission

No significant findings.

X-ray

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.

X-ray

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.

X-ray

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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Case information

rID: 75359
Published: 7th Apr 2020
Last edited: 7th Apr 2020
System: Chest
Inclusion in quiz mode: Included
Institution: Hospital Doctor Peset

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