The child’s weight was 16 kg, height 91 cm, admission temperature 39.6 °C, pulse rate 120 bpm, and respiratory rate 28 breaths/min. He had good nutritional status, normal development, no rash on the skin or mucous membranes throughout the body, no pharyngeal hyperemia, and no enlargement and purulent discharge of tonsils, and superficial lymph nodes in the entire body were not palpable. Breath was regular and orderly, breath sounds in both lungs were rough, and crackles could be heard. The heart rhythm was aligned. Pericardial rub, additional heart sounds, and pathological murmur were not heard on auscultation. The abdominal examination was normal. The liver, gallbladder and spleen were not palpable, percussion pain in both kidney areas was negative, and neurological examination was normal.
On January 27, 2019, routine blood tests showed white blood cell count (WBC) 7.15 × 109/L, neutrophil (NEU) 59.90%, lymphocyte (LYM) 31.20%, monocyte (MON) ratio 8.50%, red blood cell count (RBC) 4.37 × 1012/L, platelet (PLT) count 159 × 109/L, abnormal LYM (YX) < 10%, and high-sensitivity C-reactive protein (hs-CRP) < 0.50 mg/L.
On January 28, 2019, procalcitonin was < 0.1 ng/mL, immunoglobulin A 0.693 g/L, and complement C3 0.720 g/L. No abnormalities were found in myocardial enzymes, liver and kidney function, and various viral antibody tests. Tuberculosis antibodies, antinuclear antibodies, rheumatoid factor detection and the anti-O test were normal.
On January 30, 2019, thyroid function tests showed T3 0.877 nmol/L, T4 52.92 nmol/L, free triiodothyronine 2.39 pmol/L, free thyroxine 9.43 pmol/L, A-thrombopoietin 96.34 IU/mL, and A-thyroglobulin 328.80 IU/mL.
On February 1, 2019, routine blood tests showed WBC 7.60 × 109/L, NEU 45.80%, LYM 36.70%, MON 8.30%, RBC 4.45 × 1012/L, PLT 253 × 109/L, and hs-CRP 11 mg/L, and D-dimer 932 μg/L. Fungal-D glucan was higher than 162 pg/mL (normal values were < 100.5 pg/mL). No abnormalities in tuberculosis-infected T cells and respiratory virus antibodies were detected.
On February 2, 2019, a blood culture was tested on the next day after admission, and the result was negative on the 7th d.
On February 4, 2019, routine blood tests showed WBC 6.42 × 109/L, NEU 38.64%, LYM 51.44%, MON 6.24%, RBC 4.20 × 1012/L, PLT 277 × 109/L, and hs-CRP < 0.50 mg/L.
On February 7, 2019, routine blood tests showed WBC 6.61 × 109/L, NEU 47.44%, LYM 39.34%, MON 8.04%, RBC 4.39 × 1012/L, PLT 272 × 109/L, and hs-CRP < 0.50 mg/L.
According to the “National Clinical Laboratory Operating Procedures” compiled by the Department of Medical Administration, Ministry of Health, China, The usual WBC count range is (4.0-10.0) × 109, the normal value for the percentage of NEUs is 50%-70%, the normal value for the LYM percentage is 20%-40%, the normal value of the percentage of monocytes is 3%-8%, the normal value of RBCs is (3.5-5.5) × 1012/L, the normal value of PLTs is (100-300) × 109/L, the normal value for the hypersensitive CRP is 0-3 mg/L.
Computed tomography (CT) scanning of the lungs was performed, with the following findings.
On January 27, 2019, the texture of both lungs was enhanced, the bronchial vascular bundle was thickened and disordered, multiple fuzzy cord shadows were seen, and the lower lobe of the right lung showed patchy dense opacity, with smooth edges and an uneven internal density (Figure 1A).
Figure 1 Computed tomography images.
A: Computed tomography (CT) images of the lungs in the child on the 19th d of infection onset and the day of admission; B: CT scan of the lungs on day 4 after admission; C: CT scan of the lungs more than 1 mo after discharge.
On January 31, 2019, compared with the previous CT images on January 27, 2019, the density of the lower lobe of the right lung had increased significantly, the edges were blurred, and an irregular cavity was seen inside. A small amount of fluid was noted in the right thorax (Figure 1B).