A Case of Focal Pulmonary Consolidation with An Air Bronchogram in A Patient with Coronavirus Disease-2019

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  • SATO Ryuichi
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • NAGASAKI Tadao
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • KUSUTA Risa
    Department of Nephrology, Osaka Saiseikai Nakatsu Hospital
  • HAMA Yuma
    Department of Nephrology, Osaka Saiseikai Nakatsu Hospital
  • UEDA Tetsuya
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • AZUMA Masanori
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • MIYAZAKI Yoshimune
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • OTA Kazuki
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • KUSAKABE Yusuke
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • FUKUSHIMA Yusei
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital
  • YASUI Yoshinori
    Infection Control Team, Osaka Saiseikai Nakatsu Hospital
  • TANAKA Atsuo
    Department of Nephrology, Osaka Saiseikai Nakatsu Hospital
  • HASEGAWA Yoshinori
    Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital

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Other Title
  • 細菌性肺炎との鑑別を要した新型コロナウイルス感染症の1 例

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Description

<p>Background：Previous reports have documented ground-glass opacities (GGOs), followed by appearance of the crazy pavement pattern and consolidation as the typical findings on chest computed tomography (CT) in patients with Coronavirus Disease-2019 (COVID-19). Case : A 69-year-old man with chronic renal failure and diabetes mellitus presented with a 2-day history of fever and fatigue, without cough or sputum production. Chest auscultation revealed coarse crackles at the right base. Laboratory findings included a normal leukocyte count, normal serum procalcitonin level, and a slightly elevated serum C-reactive protein level. Chest CT performed on day 2 after symptom onset revealed consolidation in the right lower lobe with an air bronchogram. The patient was tentatively diagnosed as having bacterial pneumonia, however, antibiotic treatment with ampicillin/sulbactam yielded no improvement of the symptoms, respiratory status, or laboratory findings. A repeat chest CT revealed changes in the findings of the right lower lobe from areas of focal consolidation to GGOs. GGOs and areas of consolidation were also detected in the other lung lobes. A polymerase chain reaction test for Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) returned a positive result. Discussion：Focal areas of lung consolidation is an atypical radiological presentation of coronavirus pneumonia. It is possible that the initial findings of CT represented those of bacterial pneumonia which responded to the antibiotic therapy, and that the GGOs that developed subsequently reflected newonset SARS-CoV-2 pneumonia. However, the symptom of fatigue without cough or sputum, a normal leukocyte count, and a poor response to antibiotics are not typical findings of bacterial pneumonia. Our experience suggests that it is important to consider other or concomitant diseases when the initial treatment is followed by a deteriorating clinical course in patients with pneumonia. Moreover, it is essential to prevent the spread of hospital-acquired infection, especially if epidemic diseases need to be included in the initial differential diagnosis. Conclusion：Patients with focal consolidations could have COVID-19. Further research into consolidation as a feature of this disease is warranted.</p>

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 95 (1), 21-26, 2021-01-20

    The Japanese Association for Infectious Diseases

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