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Case Reports
. 2017 Nov;23(11):769-773.
doi: 10.1016/j.jiac.2017.04.004. Epub 2017 May 23.

Atypical presentations of MERS-CoV infection in immunocompromised hosts

Si-Ho Kim  1 , Jae-Hoon Ko  1 , Ga Eun Park  1 , Sun Young Cho  1 , Young Eun Ha  1 , Ji-Man Kang  2 , Yae-Jean Kim  2 , Hee Jae Huh  3 , Chang-Seok Ki  3 , Byeong-Ho Jeong  4 , Jinkyeong Park  5 , Jun Ho Jang  6 , Won Seog Kim  6 , Cheol-In Kang  1 , Doo Ryeon Chung  1 , Jae-Hoon Song  1 , Kyong Ran Peck  7
Affiliations
Case Reports

Atypical presentations of MERS-CoV infection in immunocompromised hosts

Si-Ho Kim et al. J Infect Chemother. 2017 Nov.

Abstract

During the 2015 Korean MERS outbreak, we experienced atypical presentations of MERS-CoV infections in three immunocompromised hosts that warranted exceptional management. Case 1 showed delayed symptom development after a four-day asymptomatic period, Case 2 experienced a 20-day incubation period, and Case 3 exhibited persistent viral shedding without clinical deterioration. Recognizing these exceptions is extremely important in the management of MERS-CoV-exposed or -infected patients and for control of potential MERS outbreaks.

Keywords: Asymptomatic period; Corticosteroid; Immunocompromised host; Incubation period; Middle East respiratory syndrome coronavirus.

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Figures

Fig. 1
Fig. 1
Clinical courses of MERS-CoV infection in three immunocompromised hosts with atypical presentation. (a) Case 1: A 42-year-old female with MDS showed delayed symptom onset after a four-day asymptomatic period. (b) Case 2: A 49-year-old female, who had received an auto-PBSCT for recurred DLBCL experienced a long incubation period of 20 days. (c) Case 3: A 34-year-old male with PTCL exhibited persistent viral shedding without clinical deterioration while using corticosteroid to control lymphoma and hemolytic anemia. Abbreviations: MERS-CoV, Middle East respiratory syndrome coronavirus; MDS, myelodysplastic syndrome; auto-PBSCT, autologous peripheral blood stem cell transplantation; DLBCL, diffuse large B-cell lymphoma; PTCL, peripheral T-cell lymphoma; rRT-PCR, real-time reverse transcriptase polymerase chain reaction; CXR, chest X-ray; BT, body temperature; Ct, threshold cycle; ICU, intensive care unit; TB, tuberculosis; Pd, prednisolone.
Fig. 2
Fig. 2
Serial chest X-ray images of Case 1. (a) Chest X-ray taken on dpex 10 showed pneumonic infiltration in left upper lobe (arrow). (b) New infiltration appeared in left lower lobe on dpex 17 (arrow). (c) Pneumonic infiltrations were markedly improved on dpex 24. Abbreviations: dpex, days post exposure.
Fig. 3
Fig. 3
Serial chest X-ray images of Case 2. (a) Chest X-ray taken on dpex 14. Bilateral micro-nodular infiltration worsened despite antibiotic treatment. (b) On dpex 18, the patient was admitted to ICU due to severe dyspnea. Chest X-ray showed aggravated infiltration in left upper and lower lobe (arrow). (c) Chest X-ray taken on dpex 25 after endotracheal intubation. Diffuse infiltration of left lung was markedly aggravated (arrow). Abbreviations: dpex, days post exposure; ICU, intensive care unit.
Fig. 4
Fig. 4
Serial chest X-ray images of Case 3. (a) On dpex 8, new infiltrations of both upper lobes were observed (arrows). (b) Chest X-ray taken on dpex 23. Both upper lobe lesions were markedly aggravated. (c) Chest X-ray taken dpex 32. Although symptom and vital signs improved after antiviral treatment, pneumonic infiltration on chest X-ray was sustained. Abbreviations: dpex, days post exposure.
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