In late January 2020, a 26-year-old woman who was 26 weeks pregnant without underlying illness was admitted to fever clinic of Union Hospital (Tongji Medical College, Wuhan, Hubei Province). She presented a history of fever and myalgia for 10 days followed by dry cough and dyspnea for 3 days. The patient is a healthcare worker in the obstetrics department of a secondary hospital in Wuhan. She had contact history with a COVID-19 patient in maternity ward 2 weeks before onset. On admission (day 1), her vital signs were normal except for elevated body temperature (38.4 °C). Auscultation revealed reduced breath sounds in both lungs. Blood oxygen saturation detected by pulse oximeter was 95%. Complete blood cell count showed normal white blood cell count (WBC, 6.54 × 109
/L, normal range 3.5–9.5 × 109
/L), mildly elevated neutrophil ratio (76%, normal range 40%–75%) and normal lymphocyte ratio (20%, normal range 20%–50%). Red blood cell count (RBC, 3.43 × 1012
/L) and hemoglobin content (106 g/L) decreased slightly. Increased level of interleukin-6 (7.98 pg/mL, normal range 0.1–2.9 pg/mL), was detected. The hypersensitive C-reactive protein level and D-dimer concentration were normal. The liver function test showed elevated alanine aminotransferase (ALT, 94 U/L, normal range 5-35 U/L) and aspartate aminotransferase (AST, 61 U/L, normal range 8-40 U/L), the serum albumin level decreased slightly (Alb, 31.3 g/L, normal range 35-55 g/L) and the total serum bilirubin level was normal (TSB, 14.6 umol/L, normal range 5.1–19.0 umol/L). The patient went through high-resolution chest CT on the day of admission. The examination was performed on a 96 row detector dual source CT scanner (SOMATOM Force, Siemens Healthineers) using the dose saving optimized mode with a lead blanket covering abdomen and pelvis of the patient. Axial images were acquired with tube voltage of 90 kVp and automatically modulated tube current, the volume CT dose index was 3.79 mGy for this scan. Axial images (thickness of 1.5 mm and increment of 1.5 mm) were reconstructed with a matrix size of 512 × 512. Images showed bilateral multifocal peribronchovascular and subpleural areas of airspace disease, affecting lower lobes more than upper lungs. The vast majority of these changes were of mixed density (with groundglass component), with one predominantly dense focus of consolidation with airbronchogram within apicoposterior segment of left upper lobe. No pleural effusion was found (Fig. 1
The throat swabs of the patient were tested positive for nuclear acid of SARS-CoV-2 by real-time fluorescent polymerase chain reaction (RT-PCR). She was treated with antiviral drugs (oseltamivir, recombinant human interferonα-2b and arbidol) and antibiotics (azithromycin, cefdinir). Besides, she received intravenous infusion of magnesium isoglycolate injection to improve hepatic function since admission. Oxygen inhalation through nasal cannula was given to relieve dyspnea with other supportive care. The patient's body temperature has decreased to 37 °C in 6 h after admission without using antipyretics, fluctuated between 36 °C and 37 °C for a week with subsequent stabilization around 36.5 °C thereafter a week later Her dyspnea and cough improved significantly after 2 days of treatment, the blood oxygen saturation rose from 95% at admission to around 98% since day 2. However, hepatic dysfunction has worsened on day 7 (ALT 510 U/L, AST 246 U/L, Alb 27.9 g/L, TSB 13.9 umol/L) despite continuous liver protection treatment. Subsequently, the hepatic function has shown improvement on day 9 after modification of liver protection medication dose and addition of reduced glutathione for injection and showed evident improvement on day 12 (ALT 247 U/L, AST 94 U/L, Alb 32.8 g/L, TSB 10.7 umol/L vs ALT 454 U/L, AST 152 U/L, Alb 31.3 g/L, TSB 10.3 umol/L). Nuclear acid test result of throat swab for the novel coronavirus turned negative on day 11 and the patient was free of symptom. However, the WBC count continued to rise slowly from 6.54 × 109/L at admission to 7.97 × 109/L on day 7, 9.04 × 109/L on day 9 and 10.95 × 109/L on day 12, the ratios of neutrophil and lymphocyte were in normal range in latter tests. To evaluate changes in lung lesions after treatment and look for possible secondary infection indicated by leukocytosis, the patient underwent a chest CT on the same CT scanner with same imaging protocol as previously described, and the volume CT dose index of the scan was 3.86 mGy. Bilateral lesions were greatly improved, the residual disease presented mainly with opacities of mixed density and ground-glass, no new foci of airspace was involved (Fig. 2
D–F). The patient was discharged from hospital on day 13 with the prescription of oral medicine of polyene phosphatidylcholine, and she was asked to stay quarantined at home for another two weeks. By the end of observation, the patient recovered well without any discomfort.