Shortly thereafter, we discovered 4 more patients infected with H7N9. Finally, 4 of the 6 patients died, while 2 patients recovered. To the best of our knowledge, this is the first report of a patient who recovered from pneumonia induced by H7N9 infection. A 40-year-old man who complained of ‘fever, cough, and blood in sputum persisting for 3 days’ was admitted to the Fifth People’s Hospital of Shanghai, Fudan University, on 6 March 2013. He had a smoking history for 20 years (approximately 800 cigarettes/year)

with an unremarkable medical history. On admission (6 March), physical examination showed a stable respiratory rate (20/min), normal blood pressure (130/80 mmHg), tachycardia (heart rate, 120 bpm), and fever (body temperature, 39 °C). Moist rales were heard in the lower lobe of MG-132 in vivo the left lung. Arterial blood gas analysis revealed hypoxaemia (arterial oxygen, 64 mmHg). Blood test showed normal white blood cell (WBC) count (4.99 × 109/L), while the percentage of neutrophils (78.4%) was higher than the normal range. Chest-CT showed multiple

areas of segmental ground-glass opacity in the middle and lower lobe of the right lung with clear signs of air bronchogram; the left lung showed no pathological abnormality, and there were no signs of enlarged mediastinal lymph nodes (Fig. 1a). The patient was initially treated by moxifloxacin and oxygen treatment Selleck Pifithrin �� (nasal catheter oxygen inhalation with an oxygen flow rate of 4 L/min). On the day after admission (7 March), laboratory tests

showed elevated enzyme levels: creatine kinase (CK), 984 Methisazone U/L, creatine kinase isoenzymes (CK-MB), 20 U/L, lactate dehydrogenase (LDH), 498 U/L, alanine aminotransferase (ALT), 46 U/L, and aspartate aminotransferase (AST), 51 U/L. The patient’s body temperature did not return to normal. We continued to obverse him while providing physical cooling. On day 2 after admission (8 March), the patient’s clinical symptoms were not resolved, and his body temperature increased to 39.7 °C. Hypoxaemia persisted after inhaling oxygen (arterial blood gas analysis: pH 7.5; arterial partial pressure of carbon dioxide, 30 mmHg; arterial partial pressure of oxygen, 64 mmHg) (Table 1). We replaced moxifloxacin with meropenem as antibacterial therapy. After 4 days of treatment (10 March), the patient’s clinical symptoms were not resolved. A blood test revealed a decreased WBC count of 3.38 × 109/L, and increased levels of ALT of 217 U/L and AST of 160 U/L (Table 1). Chest-computed tomography (CT) showed that the opacities had become more confluent and dense, with a new large field of opacities in the right lung and patchy opacities in the lower lobe of the left lung. Inflammation had also clearly progressed (Fig. 1b). On the same day, a 27-year-old male patient died of progressive pneumonia and acute respiratory distress syndrome.