case_images: PMC7447559_01
case_images: PMC7447559_02
case_images: PMC7447559_03
case_images: Chest computed tomography scan on admission. A slight infiltrative shadow was observed on both sides.
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case_images: PMC7447559_03_AMS2-7-e552-g001.jpg
case_images: ams2552-fig-0001
case_images: Chest computed tomography showed mild infiltrates in both lungs (Fig. 1). Chest radiographs showed infiltrative shadows on both lungs (Fig. 2A); besides, her PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen [P/F]) ratio was 112 and heart failure was negative on echocardiography.
case_images: Changes in chest radiographs. A, X-ray photograph at the time of visit. A slight infiltrative shadow is seen on both sides. B, X-ray photograph on the third day after hospitalization. Although the infiltrative shadows on both sides were exacerbated, the respiratory condition gradually improved from this day. C, X-ray photograph on the fifth day after hospitalization. The infiltration shadow gradually improved. D, X-ray photograph taken 10 days after admission. The infiltration shadow has disappeared.
case_images: AMS2-7-e552-g002.jpg
case_images: PMC7447559_03_AMS2-7-e552-g002.jpg
case_images: ams2552-fig-0002
case_images: Chest computed tomography showed mild infiltrates in both lungs (Fig. 1). Chest radiographs showed infiltrative shadows on both lungs (Fig. 2A); besides, her PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen [P/F]) ratio was 112 and heart failure was negative on echocardiography.
case_images: Clinical course and transition of each marker. From the second day after admission, MMP-1 decreased rapidly. Along with that, the respiratory condition gradually improved. The TIMP-1/MMP-1 ratio changed in parallel with the P/F ratio. MMP-1, matrix metalloproteinase-1; TIMP-1, tissue inhibitors of metalloproteinase-1; P/F, partial pressure of arterial oxygen/percentage of inspired oxygen..
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case_images: PMC7447559_03_AMS2-7-e552-g003.jpg
case_images: ams2552-fig-0003
case_images: In addition, proteolytic enzyme inhibitors, ulinastatin and nafamostat, were administered, and a continuous administration of a steroid (methylprednisolone 1 g/day) was started (Fig. 3). TIMP-1 remained high (Fig. 3). Tumor necrosis factor-alpha (TNF-alpha) was below the measurement limit during the entire course. The P/F ratio rapidly increased from the third day after admission and she was extubated the tenth day after admission (Fig. 3). Figure 3 shows the course of the P/F ratio, MMP-1 value, and TIMP-1/MMP-1 ratio.