28100279 Visualization

A 39 Age - year Age - old Age Korean Personal_background male Sex come Clinical_event to our hospital Nonbiological_location complaining of cough Sign_symptom , myalgia Sign_symptom , and fever Sign_symptom that had lasted Duration for Duration 5 Duration days Duration .
He was a company Occupation worker Occupation and denied History any History previous History medical History histories History .
He was a current History smoker History and drank History alcohol History about History once History a History month History .
His vital Diagnostic_procedure signs Diagnostic_procedure were: blood Diagnostic_procedure pressure Diagnostic_procedure , 100/60 Lab_value mmHg Lab_value , heart Diagnostic_procedure rate Diagnostic_procedure , 100/min Lab_value , respiratory Diagnostic_procedure rate Diagnostic_procedure , 25 Lab_value breaths/min Lab_value , and body Diagnostic_procedure temperature Diagnostic_procedure , 39 Lab_value °C Lab_value .
On the physical Diagnostic_procedure examination Diagnostic_procedure , decreased Lab_value breathing Diagnostic_procedure sound Diagnostic_procedure was noted in the right Biological_structure lower Biological_structure lung Biological_structure .
Laboratory Diagnostic_procedure tests Diagnostic_procedure revealed a c Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure ( CRP Diagnostic_procedure ) level of 119 Lab_value mg/dL Lab_value , a total Diagnostic_procedure bilirubin Diagnostic_procedure level of 1.8 Lab_value mg/dL Lab_value , and alanine Diagnostic_procedure transaminase Diagnostic_procedure and aspartate Diagnostic_procedure transaminase Diagnostic_procedure levels of 250 Lab_value and 172 Lab_value IU/L Lab_value , respectively.
His platelet Diagnostic_procedure count Diagnostic_procedure was 98,000/mm3 Lab_value , while his white Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure was 8150/mm3 Lab_value ( neutrophil: Lab_value 85% Lab_value ).
In the arterial Diagnostic_procedure blood Diagnostic_procedure gas Diagnostic_procedure analysis Diagnostic_procedure checked in Detailed_description room Detailed_description air Detailed_description , pH Diagnostic_procedure , PaCO2 Diagnostic_procedure , PaO2 Diagnostic_procedure , bicarbonate Diagnostic_procedure , and oxygen Diagnostic_procedure saturation Diagnostic_procedure levels were 7.50 Lab_value , 34 Lab_value mmHg Lab_value , 67 Lab_value mmHg Lab_value , 26.5 Lab_value mmol/L Lab_value , and 95% Lab_value , respectively.
A test Diagnostic_procedure for Diagnostic_procedure the Diagnostic_procedure human Diagnostic_procedure immunodeficiency Diagnostic_procedure virus Diagnostic_procedure was negative Lab_value .
Mycoplasma Detailed_description and Chlamydia Detailed_description antibodies Diagnostic_procedure were negative Lab_value .
Streptococcal Detailed_description and Legionella Detailed_description urinary Diagnostic_procedure antigens Diagnostic_procedure were negative Lab_value .
Anti Detailed_description - nuclear Detailed_description and anti Detailed_description - neutrophilic Detailed_description cytoplasmic Diagnostic_procedure antibodies Diagnostic_procedure were also negative Lab_value .
A chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure showed consolidation Sign_symptom in the right Biological_structure mid Biological_structure to Biological_structure lower Biological_structure lung Biological_structure fields Biological_structure .
Chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure showed consolidation Sign_symptom with surrounding Texture ground Texture glass Texture opacity Texture in the right Biological_structure middle Biological_structure lobe Biological_structure with a small Severity amount Severity of pleural Disease_disorder effusion Disease_disorder in the right Biological_structure hemithorax Biological_structure (Fig.1).
Abdominal Biological_structure sonography Diagnostic_procedure revealed no Lab_value abnormal Lab_value finding Lab_value in the hepatobiliary Biological_structure system Biological_structure .
We began to administer 4 Dosage L/min Dosage of oxygen Medication nasally Administration and empirical antibiotics Medication with third generation cephalosporin Medication and macrolide Medication following a diagnosis of community Detailed_description - acquired Detailed_description pneumonia Disease_disorder .
On the second Date day Date in the hospital, the patient’s fever Sign_symptom was sustained and he complained of dyspnea Sign_symptom .
His hypoxemia Sign_symptom was aggravated such that he required 7 Dosage L/min Dosage of oxygen Medication via a simple Administration mask Administration and the consolidation Sign_symptom and pleural Disease_disorder effusion Disease_disorder had markedly progressed (Fig.2a).
We performed bronchoscopy Diagnostic_procedure and thoracentesis Therapeutic_procedure .
Multiplex Detailed_description real Diagnostic_procedure - time Diagnostic_procedure reverse Diagnostic_procedure transcriptase Diagnostic_procedure polymerase Diagnostic_procedure chain Diagnostic_procedure reaction Diagnostic_procedure ( RT Diagnostic_procedure - PCR Diagnostic_procedure ) for Detailed_description respiratory Detailed_description viruses Detailed_description using Detailed_description bronchoalveolar Detailed_description lavage Detailed_description fluid Detailed_description was positive Lab_value for Lab_value human Lab_value adenovirus Lab_value while other microbiological Diagnostic_procedure studies Diagnostic_procedure were negative Lab_value .
Pleural Diagnostic_procedure fluid Diagnostic_procedure was lymphocyte Lab_value - dominant Lab_value exudate Lab_value and was also positive Lab_value for Lab_value human Lab_value adenovirus Lab_value .
Under the diagnosis of adenovirus Disease_disorder pneumonia Disease_disorder , we started antiviral Medication therapy Medication with oral Administration ribavirin Medication 400 Dosage mg Dosage q Dosage 12 Dosage h Dosage while maintaining antibiotics Medication .
On hospital day Date 4 Date , his fever Sign_symptom had subsided and symptoms Sign_symptom were much improved.
The transaminase Diagnostic_procedure levels, CRP Diagnostic_procedure and platelet Diagnostic_procedure counts gradually normalized Lab_value (Fig.3).
A follow Clinical_event - up Clinical_event chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure was clear Lab_value (Fig.2b) and he was discharged Clinical_event in hospital day Date 13 Date without any complications Sign_symptom .