[Clinical feature changes of a COVID-19 patient from mild to critical condition and cardiopulmonary pathological results].

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[Clinical feature changes of a COVID-19 patient from mild to critical condition and cardiopulmonary pathological results].

Zhonghua Xin Xue Guan Bing Za Zhi. 2020 May 26;48(0):E018

Authors: Jiang SW, Gao H, Wu L, Wang GW, Cen FL, Li JX, Feng C, Wen JM, Chen Y, He RL, Qiao K, Wang Y, Liu YX, Wang ZQ

Objective: To analyse the clinical history, laboratory tests and pathological data of a patient who suffered from novel coronavirus pneumonia(COVID-19) and provide reference for the clinical treatment of similar cases. Methods: Data of clinical manifestation, laboratory examination, bronchoscopy, echocardiography and cardiopulmonary pathological results were retrospectively reviewed in a case of COVID-19 with rapid exacerbation from mild to critical condition. Results: This patient hospitalized at day 9 post 2019 novel coronavirus(2019-nCoV) infection, experienced progressive deterioration from mild to severe at day 11, severe to critical at day 18 and underwent extracorporeal membrane oxygenation(ECMO) and continuous renal replacement therapy(CRRT) as well as heart lung transplantation during day 28-45 day post infection, and died on the second day post heart and lung transplantation. The patient had suffered from hypertension for 8 years. At the early stage of the disease, his symptoms were mild and the inflammatory indices increased and the lymphocyte count decreased continuously. The patient’s condition exacerbated rapidly with multi-organ infections, and eventually developed pulmonary hemorrhage and consolidation, pulmonary hypertension, right heart failure, malignant ventricular arrhythmias, liver dysfunction, etc. His clinical manifestations could not be improved despite viral RNAs test results became negative. The patient underwent lung and heart transplantation and finally died of multi organ failure at the second day post lung and heart transplantation. Pathological examination indicated massive mucus, dark red secretions and blood clots in bronchus. The pathological changes were mainly diffused pulmonary hemorrhagic injuries and necrosis, fibrosis, small vessel disease with cardiac edema and lymphocyte infiltration. Conclusions: The clinical course of COVID-19 can exacerbate rapidly from mild to critical with lung, liver and heart injuries. Steadily increased inflammation indices are suggestive of irreversible disease progression and worse outcome. In the early stages of the disease, the progress of the disease should be closely observed and evaluated, and the factors related to the progress of the disease should be identified and managed.

PMID: 32455515 [PubMed – as supplied by publisher]

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