Computed tomography findings and clinical evidence of improvement in coronavirus disease 2019 infection after convalescent plasma therapy in a critically ill patient

Bangguo Tan; Jing Ou; Rui Li; Fulin Lu; Xiaoming Zhang; Tianwu Chen; Hongjun Li

doi:10.4103/RID.RID_32_22

CASE REPORT

Year : 2022 | Volume : 9 | Issue : 3 | Page : 100-103

Computed tomography findings and clinical evidence of improvement in coronavirus disease 2019 infection after convalescent plasma therapy in a critically ill patient

Bangguo Tan¹, Jing Ou¹, Rui Li¹, Fulin Lu¹, Xiaoming Zhang¹, Tianwu Chen¹, Hongjun Li²
¹ Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
² Department of Radiology, Beijing You An Hospital, Capital Medical University, Beijing, China

Date of Submission	12-Aug-2022
Date of Decision	30-Aug-2022
Date of Acceptance	20-Sep-2022
Date of Web Publication	22-Dec-2022

Correspondence Address:
Hongjun Li
Department of Radiology, Beijing YouAn Hospital, Capital Medical University, 8# Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069
China
Tianwu Chen
Department of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong, Sichuan
China

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/RID.RID_32_22

Abstract

The spread of severe acute respiratory syndrome coronavirus 2 worldwide has created a major threat to human life and safety. Antiviral drugs and antibiotics have poor therapeutic effects, and there is no specific treatment for this virus. Chest computed tomography (CT) plays an important role in the diagnosis and management of coronavirus disease 2019 (COVID-19). We report a patient who was critically ill with COVID-19 and recovered after receiving transfusions of convalescent plasma. To evaluate the efficacy of convalescent plasma in the treatment of COVID-19, we compared chest CT findings, clinical manifestations, and laboratory findings before and after treatment with convalescent plasma. After the transfusion of convalescent plasma, clinical manifestations and indicators of inflammation improved, accompanied by an increase in the partial pressure of oxygen and oxygen saturation. Chest CT showed some resolution of the lung lesions, and multiple viral nucleic acid tests were negative. Therefore, the patient's condition was improved after the transfusion of convalescent plasma, suggesting that it may be an effective treatment for patients who are critically ill with COVID-19.

Keywords: Computed tomography, convalescent plasma, coronavirus, pneumonia

How to cite this article:
Tan B, Ou J, Li R, Lu F, Zhang X, Chen T, Li H. Computed tomography findings and clinical evidence of improvement in coronavirus disease 2019 infection after convalescent plasma therapy in a critically ill patient. Radiol Infect Dis 2022;9:100-3

How to cite this URL:
Tan B, Ou J, Li R, Lu F, Zhang X, Chen T, Li H. Computed tomography findings and clinical evidence of improvement in coronavirus disease 2019 infection after convalescent plasma therapy in a critically ill patient. Radiol Infect Dis [serial online] 2022 [cited 2023 Jun 5];9:100-3. Available from: http://www.ridiseases.org/text.asp?2022/9/3/100/364775

Introduction

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was first reported in Wuhan, Hubei Province, China, in December 2019 and has since spread to many countries.^[1] In China, COVID-19 is classified as a Class B infectious disease but is managed as a Class A infectious disease. The most common symptoms of COVID-19 are fever, cough, and dyspnea. However, some of these patients develop more serious manifestations, such as respiratory failure, shock, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and disseminated intravascular coagulation, which may lead to death.^[2] At present, only symptomatic and supportive treatment is available for COVID-19. No effective antiviral drugs against SARS-CoV-2 have been identified. Therefore, there is no consensus on the optimal treatment for COVID-19.^[3] Chest computed tomography (CT) is highly sensitive for detecting pulmonary lesions, and changes in chest CT findings reflect the evolution of a patient's condition. Therefore, CT scans are a good method of evaluating the severity of this disease.^[4] In the early stages of the epidemic, we administered convalescent plasma to a patient in our hospital who was critically ill with COVID-19 and subsequently recovered. We report the successful treatment of this case, focusing on CT findings, clinical manifestations, and laboratory findings.

Case Report

The patient was a 60-year-old man with a history of exposure in Wuhan who reported having had pharyngeal itchiness, cough, fever, and dyspnea of no obvious cause for 10 days before being transferred to our hospital. When he first developed these symptoms, he had been admitted to a county-level hospital with a body temperature of 38.7°C. During that hospitalization, a SARS-CoV-2 nucleic acid test was positive. He was administered antibiotics and antiviral agents, high-flow oxygen, and other symptomatic treatments. His condition progressively worsened, which led to his transfer to our hospital. On admission to our hospital, he was administered ritonavir and lopinavir for antiviral therapy, and imipenem and cilastatin for bacterial infection. A blood gas analysis after admission showed severe hypoxemia. High-flow oxygen (7 L/min) was administered through a nasal cannula, and his blood gas concentrations were monitored. His dyspnea persisted, which led to a progressive increase in the oxygen flow rate from 7 L/min to 9 L/min to 12 L/min, and finally to 19 L/min. A blood gas analysis showed that his partial pressure of oxygen and oxygen saturation remained low. He was started on noninvasive mechanical ventilation when his oxygen concentration fell to 65%. Despite these treatments, the patient's condition gradually progressed to acute respiratory distress syndrome and multiple organ dysfunction syndrome. He began treatment with lopinavir and ritonavir combined with interferon as antiviral treatment, piperacillin, tigecycline, imipenem, and cilastatin as antibacterial treatment, and methylprednisolone as anti-inflammatory therapy. However, his severe fever and hypoxemia persisted. We obtained approval from the Ethics Committee of our hospital and an expert group for the treatment of COVID-19 for further proposed treatment. We also obtained consent from members of the patient's family on days 13, 14, and 16 after admission to our hospital for the proposed treatment. We then transfused 200, 100, and 200 mL on days 13, 14, and 16, respectively (total of 500 mL), of convalescent plasma from patients who had recovered from COVID-19. Within 72 h before and after each transfusion of convalescent plasma, there were essentially no changes in the drugs administered.

Efficacy evaluation

Thirty-six hours after the first transfusion of convalescent plasma, multiple SARS-CoV-2 nucleic acid tests on nine samples of deep sputum, one throat swab, and two stool tests were negative. In addition, within 72 h after the first transfusion of convalescent plasma, the patient's symptoms improved, his body temperature and indicators of inflammation decreased, and his partial pressure of oxygen and oxygen saturation increased.

The patient's chest CT findings greatly changed from before to after transfusion of convalescent plasma [Figure 1]. Before commencing these transfusions, the patient's condition was markedly deteriorated, and a series of chest CT scans showed progression of his pulmonary lesions. Three days before the first transfusion of convalescent plasma, a chest CT examination showed multiple, bilateral, central and peripheral, patchy, mixed ground-glass opacities (GGOs) with consolidation; these are typical CT findings in patients with COVID-19. Two hours before the first transfusion of convalescent plasma, another CT scan showed that the extent and density of his pulmonary lesions had increased. After the transfusion, the patient's condition improved, and chest CT showed a decrease in the number and size of the pulmonary lesions. One day after the third transfusion of convalescent plasma, another CT scan showed a further decrease in the extent and density of his pulmonary lesions. Thirty-three days after the third transfusion of convalescent plasma, chest CT showed obvious improvement in his mixed GGOs and pulmonary consolidation. Approximately 2 months after the third transfusion of convalescent plasma, chest CT showed almost complete resolution of the previously mixed GGOs and consolidation.

Figure 1: Sequential CT images. Three days (a-c) and 2 h (d-f) before the first transfusion of convalescent plasma, axial CT images at different levels and coronal reconstruction show an increase in multiple central and peripheral patchy mixed GGOs with consolidation. One day after the third transfusion of convalescent plasma, chest CT images (g-i) show that the lesions have partially resolved compared with 2 h before the first convalescent plasma treatment. Thirty-three days (j) and approximately 2 months (k and l) after the third transfusion of convalescent plasma, CT images show that the lesions have almost completely resolved. CT: Computed tomography, GGOs: Ground-glass opacities

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Discussion

COVID-19 is mainly transmitted by air and close contact. The explosion in numbers of confirmed patients with COVID-19 has been overwhelming. As of September 23, 2020, 90,908 cases of COVID-19 had been diagnosed in China, culminating in 4744 deaths. Outside China, 31,726,823 cases have been diagnosed, and the number of newly diagnosed cases continues to increase. The COVID-19 pandemic has greatly threatened human health. The World Health Organization has accordingly defined this pandemic as a global public health emergency.^[5] There is an urgent need for effective treatment for COVID-19, and convalescent plasma may be one such treatment.

Convalescent plasma therapy, which is an important strategy for treating infectious diseases, has received extensive attention. A study of 40 patients with severe acute respiratory syndrome by Soo et al. showed that transfusion of convalescent plasma achieved a higher cure rate and a lower mortality rate.^[6] They also found that the administration of convalescent plasma early in the course of this disease was even more effective. Ko et al. showed that convalescent plasma is an effective treatment for Middle East respiratory syndrome.^[7] During the outbreak of Ebola virus in West Africa, the administration of convalescent plasma improved patients' symptoms and reduced their mortality.^[8] The mechanism of action of convalescent plasma therapy is passive immunization. The USA Food and Drug Administration has approved this strategy, particularly for critically ill patients with COVID-19.^[9] The convalescent plasma of recovered patients contains specific antibodies that can inhibit viral replication, promote viral clearance, and reduce viral load, thereby improving survival.^[10] In the present case, we administered convalescent plasma to a critically ill patient with COVID-19, and he subsequently recovered.

Chest CT is the first-line form of imaging and plays an important role in the diagnosis and management of COVID-19. We performed CT scans to monitor changes in manifestations of COVID-19 in a critically ill patient before and after administration of convalescent plasma and to document its therapeutic effects. Multifocal bilateral GGOs or mixed GGOs and patchy consolidation, traction bronchiectasis, and vascular enlargement within lesions are the most common chest CT findings in patients with COVID-19.^[11],[12] Changes in these findings reflect progression of and recovery from this disease. In patients with COVID-19, there are approximately four stages of lung involvement according to chest CT.^[13] In the earliest stage, the main chest CT finding is subpleural GGOs distributed throughout the lower lobes. In the progressing stage, the patient's condition deteriorates rapidly, and GGOs with consolidation extend into multiple lobes on both sides. In the peak stage, the lung lesions gradually increase in size and number, and consolidation becomes more prominent. Finally, in the absorption stage, the lung lesions gradually resolve, leaving extensive bands of subpleural parenchyma.

The findings in our case suggest that convalescent plasma transfusion has a beneficial effect. However, a large study and further evidence-based data on the effects of treatment with convalescent plasma on COVID-19 are required before definite conclusions can be drawn.

In conclusion, convalescent plasma is potentially an effective treatment for COVID-19. Chest CT is an important method of monitoring lung changes in patients who are critically ill with COVID-19 before and after they undergo transfusion of convalescent plasma.

Acknowledgment

We thank Dr. Trish Reynolds, MBBS, FRACP, from Liwen Bianji (Edanz) (http://www.liwenbianji.cn/), for editing the English text of a draft of this manuscript.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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