Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://www.journalmc.org

Case Report

Volume 11, Number 10, October 2020, pages 330-335

A Case of COVID-19 Failed in Viral Identification but Showed Consistent Host Responses to Severe Acute Respiratory Syndrome Coronavirus 2

Figures

Figure 1.
Figure 1. Chest X-ray images on day 1, 8, and 28. A wedge-shaped opacity with a relatively clear margin was observed in the right middle lung zone (black arrow) on day 1. That opacity turned blurred and extended in the lower lung field (gray arrow) on day 8, then diminished (white arrow) on day 28. The radiolucency of left lower lung field was reduced on day 28 due to pleural effusion (see Fig. 2).
Figure 2.
Figure 2. Axial chest CT images on day 1, 10, and 29. An opacity found in the chest X-ray (Fig.1) was consolidative in S6 of the right lung (black arrow) on day 1. That consolidation became blurred and extended as GGO (thin gray arrow) and similar shadows also appeared in the left lung (thick gray arrow) on day 10. These shadows diminished except for left pleural effusion on day 29 (white arrow). That effusion was gradually decreasing with adjustment of body fluid by dialysis sessions. CT: computed tomography; GGO: ground glass opacification.
Figure 3.
Figure 3. Axial chest CT images on day 10. Reticular shadows with a peripheral distribution, partially with crazy-paving appearance, scattered in the bilateral lungs. CT: computed tomography.
Figure 4.
Figure 4. Clinical course. The inflammation signs were initially reduced with the treatments against COVID-19, but they flared up again around day 26. Additional steroid therapy against a possible cytokine storm succeeded in reducing symptoms. COVID-19: coronavirus disease 2019; O2 inhalation: oxygen inhalation of 1 - 2 L/min through a nasal cannula; MFLX: moxifloxacin; MEPM: meropenem; mPSL: methyl prednisolone.

Tables

Table 1. Laboratory Findings Before the Dialysis Session on Day 1
 
ParameterValueUnit
AST: aspartate aminotransferase (GOT); ALT: alanine aminotransferase (GPT)
White blood cells4,630/µL
  Neutrophils76.8%
  Lymphocytes11.2%
  Basophils0.4%
  Eosinophils4.3%
  Monocytes7.3%
Red blood cells353× 104/µL
Hemoglobin11.4g/dL
Hematocrit33.5%
Platelets7.3× 104/µL
Total protein6.6g/dL
Albumin3.8g/dL
Blood urea nitrogen73mg/dL
Creatinine9.46mg/dL
Na (Sodium)136.3mEq/L
K (Potassium)4.61mEq/L
Chloride96.3mEq/L
Calcium8.4mg/dL
Inorganic phosphorus4.5mg/dL
AST32U/L
ALT27U/L
Glucose215mg/dL

 

Table 2. Parameters in Diagnosis of COVID-19
 
ParameterUnitDay 1Day 5Day 8Day 10Day 12Day 15Day 18Day 21Day 25Day 28Day 30Day 32Day 35Day 42
LDH: lactate dehydrogenase; IL-6: interleukin-6; CF: complement fixation test; CMV: cytomegalovirus; Ag: antigen; HRP: horseradish peroxidase; ELISpot: enzyme-linked immune absorbent spot; M. tuberculosis: Mycobacterium tuberculosis; RT-PCR: reverse transcription-polymerase chain reaction; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; IgM: immunoglobulin M.
Lymphocyte count/µL519509323331259428478389259421400
LDHU/L276277366309258241213248240229180
Glycoalbumin%38.138.0
C-reactive proteinmg/dL0.582.752.007.218.613.672.685.315.003.471.400.97
Procalcitoninng/mL0.89
KL-6U/mL188
Fibrinogenmg/dL423361283208
D-dimersµg/mL1.568.9814.2813.28
IL-6pg/mL42.0
Influenza A antibodies (CF)×88
Influenza B antibodies (CF)×< 4< 4
CMV antibodies (CF)×88
CMVpp65Ag C7-HRP+/--
β-D-glucanpg/mL6.131.5
Cryptococcus neoformans antigen+/---
Aspergillus antigen+/---
ELISpot (for M. tuberculosis)+/--
RT-PCR for SARS-CoV-2+/------
SARS-CoV-2 antibodies IgM+/--+++
SARS-CoV-2 antibodies IgG+/---+
Blood culture+/---