TYPE: Case Report
TOPIC: Chest Infections
INTRODUCTION: Amidst the COVID-19 pandemic physicians treated numerous patients exhibiting a wide array of COVID-related symptoms; they were trained to detect subtle and non-specific symptoms and treat almost everyone as a suspected COVID-19 patient.
CASE PRESENTATION: A 50-year-old male was brought to the ED with suspected SARS-CoV2 infection, having a 4-day history of dry cough, fever and shortness of breath, with SpO2 of 80% on room air. He was otherwise fit and healthy, non-smoker, working as a cow farmer. The physical examination was unremarkable except for bilateral crackles on auscultation. The patient was immediately subject to RT-PCR test for SARS-CoV-2 that was negative. His blood work demonstrated thrombopenia, increased AST, ALT, as well as CRP. The chest X-ray and CT scan revealed bilateral ground-glass infiltrates (Fig. 1) and he was subject to another RT-PCR test for SARS-CoV-2. Upon negative result, he was transferred to the Respiratory clinic in isolation, where he was subject to RT-PCR testing two more times. Fig. 1: Chest X-ray and CT scan of the patient. Serologic testing was positive for Leptospirosis; subsequent transthoracic echocardiogram was suggestive of myocarditis with diffuse hypokinesis, verified with a cardiac MRI. The patient received Ceftriaxone, Moxifloxacin and diuretics, with clinical, respiratory and radiologic improvement.
DISCUSSION: The high prevalence of COVID-19 within the past years has inevitably affected the differential diagnosis process, especially in respiratory conditions. This case is exemplar of this COVID-19 pursuit where other diagnoses seem distant.
CONCLUSIONS: It is essential that physicians maintain an open mind and consider a broad set of differential diagnoses.
DISCLOSURE: Nothing to declare.
KEYWORD: COVID-19