COVID-19 pneumonia

Case contributed by Dr Ammar Ashraf

Presentation

Primary health care worker with shortness of breath and productive cough for two weeks. History of worsening shortness of breath, orthopnea, fever, myalgia, and altered taste sensation for last three days. History of recent contact with a COVID-19 positive case.

Patient Data

Age: 50 years
Gender: Male
X-ray

Suspicion of an inhomogeneous opacity in the peripheral right lower lung zone. Left lung is well-aerated and clear. No pleural effusion or pneumothorax is seen.

CT

Findings:  Scan demonstrates multiple scattered wide spread ground glass opacities in both lungs, particularly affecting the lower lobes. No pleural effusion, pneumothorax, or significant mediastinal lymphadenopathy is seen.  

Conclusion: Multiple scattered wide spread ground glass opacities in both lungs, particularly affecting the lower lobes. Considering the patient's history and exposure to the positive COVID-19 case, CT features are suggestive of COVID-19 pneumonia. 

The patient tested positive for COVID-19. Other laboratory investigations showed high LDH, ferritin, CRP, and creatine kinase (CK, CPK) levels. WBCs, D-dimer, CK-MB & troponin I were normal.

Case Discussion

Patients with SARS-CoV-2 (COVID-19) infection primarily present with respiratory tract symptoms, like cough, difficulty in breathing, and fever 1. Patients may also complain of disturbance in sense of smell & taste, fatigue, myalgia, and joint pains 1.  

Rhabdomyolysis (skeletal muscle damage & necrosis) can be caused by different viral and bacterial infections. The influenza, parainfluenza, cytomegalic virus (CMV), Epstein Barr virus (EBV), Herpes Simplex virus (HSV), and Human Immunodeficiency Virus (HIV), are some well-known acute viral infections associated with rhabdomyolysis. Creatine kinase (CK), a muscle enzyme, is markedly elevated in rhabdomyolysis 1.

Rhabdomyolysis can infrequently be seen in COVID-19 infection; however, this association is not well known. Recently, there is a case report of two patients who presented with rhabdomyolysis as the initial manifestation of COVID-19 infection with no respiratory symptoms 1. There is also a recent case report of a patient having rhabdomyolysis as a late complication of COVID-19 2.

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Case information

rID: 79551
Published: 29th Jun 2020
Last edited: 30th Jun 2020
System: Chest
Inclusion in quiz mode: Included
Institution: King Abdulaziz Hospital Al Ahsa (MNGHA)

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