case_images: PMC9207265_01
case_images: Chest CT of the patient on day 2 and day 3 (On admission) after illness onset. Red dotted arrow: multiple ground glass opacities (GGOs); Black dotted arrow: consolidation.
case_images: fmed-09-925703-g0001.jpg
case_images: PMC9207265_01_fmed-09-925703-g0001.jpg
case_images: F1
case_images: Chain Reaction (RT-PCR) test for SARS-CoV-2 and a chest computed tomography (CT) examination because of a travel history from Wuhan City within 14 days. The results showed positive to SARS-CoV-2 and multiple GGOs in the right lower lobe (Figure 1). Consequently, she was referred to the Changsha Public Health Center for isolation and hospitalization (day 3). A and B viruses were normal. A reviewed chest high resolution CT taken on February 3 (day3) presented new and progressive, diffuse, peripheral GGOs in the right upper lobe, right middle lobe and left lower lobe, and consolidation in the right lower lobe (Figure 1), typical of acute COVID-19.
case_images: Chest CT on day 61 (Starting taking pirfenidone), day 130 (At discharge), day 340 and day 758 after illness onset. Red solid arrows: subpleural reticular abnormalities and fibrous cords. Black solid arrow: interlobular septal thickening. Purple solid arrow: traction bronchiectasis. Blue solid arrow: honeycomb-like change under the subpleura.
case_images: fmed-09-925703-g0002.jpg
case_images: PMC9207265_01_fmed-09-925703-g0002.jpg
case_images: F2
case_images: Chest CT scanned on day 61 showed diffuse interstitial changes, with extensive areas of subpleural and peribronchovascular septal thickening, subpleural reticular abnormalities, traction bronchiectasis, and honeycomb-like changes under the subpleura in both lung fields, which manifested as interstitial lung disease (ILD) (Figure 2), and she started taking pirfenidone (Initially 600 mg per day, after 1 week maintain 1,800 mg per day). After 2 months of therapy, her dyspnea and pulmonary fibrosis improved (Figure 2), and subsequently, the patient was discharged on day 130, with a level of modified Medical Research Council Dyspnea Scale (mMRC) at 4 (Table 1). Reticular abnormalities, interlobular septal thickening and honeycomb-like changes were reduced in bilateral lung fields on chest CT screened on day 758 (Figure 2).