title: 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.
authors.affiliation: University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: Man-Fai
authors.initials: MF
authors.lastname: Lam
authors.forename: Gaik C
authors.initials: GC
authors.lastname: Ooi
authors.forename: Bing
authors.initials: B
authors.lastname: Lam
authors.forename: James C
authors.initials: JC
authors.lastname: Ho
authors.forename: Wing H
authors.initials: WH
authors.lastname: Seto
authors.forename: Pak L
authors.initials: PL
authors.lastname: Ho
authors.forename: Poon C
authors.initials: PC
authors.lastname: Wong
authors.forename: Raymond
authors.initials: R
authors.lastname: Liang
authors.forename: Wah K
authors.initials: WK
authors.lastname: Lam
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Tsang
mesh_terms: D000900:Anti-Bacterial Agents; D016026:Bone Marrow Transplantation / Q000276:immunology; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D013902:Radiography, Thoracic; D018570:Risk Assessment; D045473:Severe acute respiratory syndrome-related coronavirus / Q000302:isolation & purification*; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents