Atypical presentation of SARS-CoV-2 infection: A case report

Abstract

Background: The first case of pneumonia subsequently attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, Hubei Province on December 8, 2019. The symptoms included fever, coughing, and breathing difficulties. A few patients with this infection may only have atypical symptoms, which could lead to a misdiagnosis and subsequently further facilitate the spread of the virus.

Case summary: A 74-year-old female patient complained of severe diarrhea. She did not have fever, coughing, or breathing difficulties. A physical examination revealed no obvious positive signs. The patient had been hypertensive for more than 10 years. Her blood pressure was well controlled. On January 9, 2020, the patient's son visited a colleague who was later confirmed positive for SARS-CoV-2 and his first close contact with our patient was on January 17. The patient was first diagnosed with gastrointestinal dysfunction. However, considering her indirect contact with a SARS-CoV-2-infected individual, we suggested that an atypical pneumonia virus infection should be ruled out. A computed tomography scan was performed on January 26, and showed ground-glass nodules scattered along the two lungs, suggestive of viral pneumonia. Given the clinical characteristics, epidemiological history, and examination, the patient was diagnosed with coronavirus disease-2019 (COVID-19).

Conclusion: Our patient had atypical symptoms of COVID-19. Careful acquisition of an epidemiological history is necessary to make a correct diagnosis and strategize a treatment plan.

Keywords: Atypical symptoms; COVID-19; Diarrhea; Ground-glass opacity; Pneumonia; SARS-CoV-2.

Figure 1

Ground-glass nodules are randomly distributed in the upper and lower lobes of the two lungs and the pleural membrane. There is a clear boundary between the nodules, which are scattered with balanced density. The overlapping blood vessels and the path and morphology of bronchi did not show significant changes.

Figure 2

Magnified image of typical ground-glass computed tomography characteristics. Ground-glass nodules are randomly distributed in the upper and lower lobes of the two lungs and the pleural membrane. There is a clear boundary between the nodules, which are scattered with balanced density. Overlapping blood vessels and the path and morphology of bronchi did not show significant changes. No swollen lymph nodes were observed in the mediastinal septum and no fluid was found in the chest.