The second patient was a 52-year-old-man who suffered from probable SARS during a nosocomial outbreak at the same hospital. He started to have fever and chills since April 21, with myalgia and headache. A dry cough developed since April 24 and a chest radiograph revealed a pneumonia patch over the right lower lung field. Acute respiratory distress syndrome and hypotension developed on April 26. Initial microbiologic workup that included blood, urine, and sputum cultures was negative, except for Vero cells from a throat swab, sputum, and stool that were positive for coronavirus. Indirect fluorescent antibody to SARS-associated coronavirus was also positive. Serum creatine kinase level increased from 378 to 7659 U/L from April 24 to 30, and renal failure developed. Serum myoglobin level on May 7 was 989 ng/mL. The patient died on May 15 because of multiple organ failure. No autopsy was performed.