On Oct 8, 2005, a previously healthy 12-year-old girl in
rural Hunan, China, developed fever, sore throat, and
cough. She consulted a village outpatient clinic 4 days
later, and was admitted to the local hospital on Oct 13. On
admission she had a fever (40·4ºC), and chest radiography
showed shadowing in the left middle and lower lobes.
Blood tests showed white cell count 3·28109
/L,
lymphocytes 0·64109
/L, platelets 94109
/L, alanine
aminotransferase 80 IU/L, and creatinine 99 mmol/L. On
Oct 16, she was taken to the Hunan Provincial Children’s
Hospital because of increasing dyspnoea and cyanosis.
Chest radiography showed diffuse bilateral consolidation
with air bronchogram. Her condition continued to
deteriorate despite oxygen therapy, broad spectrum
antibiotics (azithromycin, cefotaxime), and corticosteroid
treatment, and she was intubated and ventilated on the
same day. She died of acute respiratory distress syndrome,
disseminated intravascular coagulation, and multiorgan
distress syndrome on Oct 17.
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