An Indolent Case of Severe Acute Respiratory Syndrome

Abstract

Severe acute respiratory syndrome (SARS) is a highly contagious and typically rapidly progressive form of atypical pneumonia, which spread from Asia to many parts of the world in early 2003. Clinical diagnosis of SARS requires the presence of unremitting fever and progressive pneumonia despite antibiotic therapy, particularly in the presence of lymphopenia and raised transaminase levels. We report the case of a woman who had undergone a successful allogeneic bone marrow transplant for acute myeloid leukemia. She presented initially with fever and a normal chest radiograph. Her indolent clinical course of SARS was punctuated by resolution of fever, but there was progressive radiologic deterioration and increasing serum antibody titer against SARS coronavirus. Treatment with oral prednisolone and ribavirin normalized her lymphopenia, altered transaminases, chest radiograph and high-resolution computed tomography appearances rapidly. Our experience should alert other clinicians in recognizing this atypical indolent presentation of SARS, to protect health care workers and the community at large and to ensure that these patients are properly treated.

A prospective study of respiratory ciliary structure and function after stem cell transplantation

“…The underlying diagnoses were acute myeloid leukemia (AML, n ¼ 3), acute lymphoblastic leukemia (ALL, n ¼ 3), chronic myeloid leukemia (CML, n ¼ 7) multiple myeloma (MM, n ¼ 2) and lymphoma (NHL, n ¼ 4). Autologous and allogeneic HSCTs were performed in three (cases 1-3) and 16 cases (cases [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], respectively, and involved unrelated donors in six cases (cases [14][15][16][17][18][19]. Four male patients (cases 1, 6, 9, 15) were ex-smokers for 1-12 years before HSCT.…”

“…The transient deterioration in case 8 may be attributed to severe acute respiratory distress syndromes (SARs). 12 Case 12 (with lowest FEV 1 at 1 year) has improved back to normal range. Case 10 continued to have mild BO, whereas case 14 developed sudden onset of severe BO at 18 months, despite a completely normal FEV 1 and CBF at 1 year.…”

Quality Control in Hospital Bone Banking

“…In the following years tissue banks developed better techniques for processing and preparation of bone allografts and more reliable blood tests came to market (Busch 1991(Busch , 1994Alter et al 1990). However, donor screening methods are constantly updated and revised with the introduction of new infectious diseases, like SARS (Lam et al 2004). The safety of allograft bone transplants can never be taken for granted, but recent safety records for bone allografts are excellent.…”

Diagnosis and pharmacotherapy of severe acute respiratory syndrome: what have we learnt?

“…These features are not specific and do not necessarily help to diagnose SARS from many other patients with non-SARS pneumonias, especially those caused by the conventional "atypical organisms", such as Mycoplasma pneumoniae or Chylamdia pneumoniae. There is little evidence of widespread subclinical or mild forms of SARS-CoV infection, although some patients with an immunocompromised state might present with indolent and, thus, less typical features [23,24]. SARS also seems to run a less aggressive clinical course in younger children, and few children with such illness required oxygen therapy [25].…”