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Case Reports
. 2003 Nov;42(5):1069-74.
doi: 10.1016/j.ajkd.2003.07.022.

Severe acute respiratory syndrome in a hemodialysis patient

Bonnie Ching-Ha Kwan  1 , Chi-Bon Leung, Cheuk-Chun Szeto, Angela Yee-Moon Wang, Philip Kam-Tao Li
Affiliations
Case Reports

Severe acute respiratory syndrome in a hemodialysis patient

Bonnie Ching-Ha Kwan et al. Am J Kidney Dis. 2003 Nov.

Abstract

Severe acute respiratory syndrome (SARS) is a highly infective disease caused by a newly identified coronavirus. We described the clinical course of the first long-term hemodialysis patient who developed SARS in the literature, and our experience in performing hemodialysis for this patient. Such patients may present with a less typical clinical picture, making diagnosis difficult. In this patient, the course of disease and duration of viral shedding was apparently prolonged, thus highlighting the need for increased infection control. Despite worsening the anemia in renal failure patients by causing hemolysis, ribavirin is well tolerated after dosage adjustment. Difficulties of diagnosis, infection control, and treatment of SARS in renal failure patients are discussed in this report.

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Figures

Fig 1
Fig 1
Serial chest radiograph: (A) on initial presentation; (B) 8 days after initial presentation, immediately before the first admission to intensive care unit; (C) 5 weeks after initial presentation, showing persistent bilateral pulmonary infiltrate despite ribavirin and corticosteroid; and (D) 8 weeks after initial presentation, showing slowly resolving pulmonary infiltrate.
Fig 2
Fig 2
Fluctuation of body temperature. Bold letters along the X-axis indicate the time at which the corresponding chest radiograph in Fig 1 was performed. Note the temporal relationship between fever, radiographic change, and treatments given. Virology results including serology and stool specimen for coronavirus isolation are also shown.
Fig 3
Fig 3
High resolution computed tomography of thorax 8 weeks after initial presentation. There is diffuse ground glass opacification, bilateral patchy consolidation, and fibrosis, features compatible with recovery phase of ARDS.
Fig 4
Fig 4
Time course of hemoglobin values and transfusions. Each triangle represents a unit of packed cell transfused. To convert hemoglobin in g/dL to g/L, multiply by 10.
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