Clinical feature changes of a COVID-19 patient from mild to critical condition and cardiopulmonary pathological results.
10.3760/cma.j.cn112148-20200304-00155
- Author:
Si Wei JIANG
1
;
Hong GAO
1
;
Lin WU
2
;
Guo Wei WANG
3
;
Fu Lan CEN
3
;
Jin Xiu LI
3
;
Cheng FENG
4
;
Jun Min WEN
5
;
Ye CHEN
6
;
Ren Liang HE
7
;
Kun QIAO
8
;
Ying WANG
7
;
Ying Xia LIU
9
;
Zhao Qin WANG
9
Author Information
1. Department of Cardiology, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
2. Department of Cardiology, Peking University First Hospital, Beijing 100034, China.
3. Intensive Care Unit, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
4. Department of Medical Ultrasonics, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
5. Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences Shenzhen, Shenzhen 518057, China.
6. Department of Hemodialysis, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
7. Department of Anesthesia, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
8. Department of Cardiothoracic Surgery, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
9. Administration Office, Shenzhen Third People's Hospitle, Shenzhen 518112, China.
- Publication Type:Journal Article
- Keywords:
COVID-19;
Extracorporeal membrane oxygenation;
Heart injuries;
Heart-lung transplantation
- MeSH:
Betacoronavirus;
COVID-19;
Coronavirus Infections/pathology*;
Fatal Outcome;
Hemorrhage/virology*;
Humans;
Lung/pathology*;
Myocardium/pathology*;
Pandemics;
Pneumonia, Viral/pathology*;
Retrospective Studies;
SARS-CoV-2
- From:
Chinese Journal of Cardiology
2020;48(7):580-586
- CountryChina
- Language:Chinese
-
Abstract:
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 12, 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 post infection, and died at 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 severe COVID-19 can exacerbate rapidly from mild to critical with lung, liver and heart injuries.
