Multiorgan dysfunction sy...

A 39-year-old doctor who was in charge of the treatment of patients with SARS in the respiratory intensive care unit developed a sudden onset of fever, chills, malaise, headache, dizziness, and myalgia and was hospitalized. Physical examination showed a temperature of 38.5C, clear lungs, and no obvious focus of infection. His fever resolved with treatment with ribavirin and methylprednisolone, and his condition improved during the first week of treatment. A chest radiograph obtained on day 11 after the onset of symptoms revealed left lower lobe infiltrates. A complete blood count demonstrated an elevated WBC count of cells/L, an increased level of neutrophils (cells/L), and lymphopenia (lymphocyte count, cells/L). Treatment with methylprednisolone was switched to 160 mg per 12 h intravenously, coincident with the initiation of antibiotic therapy. His condition gradually improved during the fourth week after onset, at which time a series of chest radiographs showed obvious resolution of the left lower lobe consolidation. His total WBC count returned to a normal level, but lymphopenia persisted. For the patient’s complaint of obscured monocular vision, an eye-ground examination was performed and revealed an exudation around the visual yellow zone on day 26 after the onset of illness. Two days later, the patient experienced dysphoria, vomiting, and deliria and was found to have progression of left lower lobe consolidation, for which he was treated with non-invasive ventilation and methylprednisolone. Despite the management described above, his condition deteriorated, and a series of chest radiographs obtained during the fifth week after onset showed progressive bibasilar infiltration with severe leukopenia (WBC count, /L), lymphopenia (lymphocyte count, cells/L), and depressed marrow. After receiving intravenous sedative, the patient developed a coma on day 33 of illness. He was transferred to the ICU. A CT scan of the brain was done. His condition rapidly deteriorated; he experienced multiorgan dysfunction syndrome, and brain herniation occurred. He died on day 3 after his admission. Serum specimens obtained from the patient at early and later phases of the illness were forwarded to the centre for ELISA and indirect fluorescence assay.