This 73-year-old male patient sought medical treatment at the emergency service at National Taiwan University Hospital (NTUH) in Taipei, Taiwan, on April 23, 2003, because of recurrent dyspnea and orthopnea. His past medical history included 3 years of type 2 diabetes mellitus, a myocardial infarct 2 years earlier, and 2 recent admissions to NTUH due to acute coronary syndrome and congestive heart failure.
On arrival at emergency service, the patient was afebrile and initial physical examination revealed a temperature of 37 C, heart rate of 112 beats per minute, and respiration rate of 24/min. Chest x-ray showed mild pulmonary congestion. The temperature elevated to 37.9 C 2 hours later, and urinalysis showed 20 to 30 white blood cells. A presumptive diagnosis of urinary tract infection and congestive heart failure was made, and the patient was treated with antibiotics, diuretics, and intravenous nitroglycerin. The patient was admitted to a cardiology ward 2 days later and became increasingly dyspneic with a nonproductive cough and persistent low-grade fever. Serial chest x-rays showed progressive lung infiltrates. A more detailed history revealed that the patient had visited Taipei Hoping City Hospital on April 15 and 16. Because this hospital was associated with a large nosocomial outbreak of SARS during late April, the patient was immediately isolated as a probable SARS case. Throat and nasopharyngeal swabs were positive for SARS-CoV by viral isolation and polymerase chain reaction (PCR) assay. He was transferred to an intensive care unit on April 29 after sudden onset of mental status changes, hypotension, and melena. The patient subsequently developed ventricular fibrillation and died 1 day later.