Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jul;96(1137):392-398.
doi: 10.1136/postgradmedj-2020-137979. Epub 2020 Jun 10.

COVID-19: to be or not to be; that is the diagnostic question

Jamie J Coleman  1   2 , Kaveh Manavi  2   3 , Ella J Marson  4   2 , Adam H Botkai  4   2 , Elizabeth Sapey  2   3
Affiliations
Review

COVID-19: to be or not to be; that is the diagnostic question

Jamie J Coleman et al. Postgrad Med J. 2020 Jul.

Abstract

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.

Keywords: infectious diseases; respiratory infections.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Case definition for COVID-19 in the UK.
Figure 2
Figure 2
Possible differential diagnosis of COVID-19.
Figure 3
Figure 3
Dual-process model of clinical reasoning adapted to COVID-19.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organisation . Coronavirus disease (COVID-19) pandemic, 2020. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [Accessed 20 Mar 2020].
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62.10.1016/S0140-6736(20)30566-3 - DOI - PMC - PubMed
    1. Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J 2020;55:2000607.10.1183/13993003.00607-2020 - DOI - PMC - PubMed
    1. Peluso MJ, Chia D, Sheen W, et al. Infectious mimicry complicates diagnosis in hemophagocytic syndrome caused by anaplastic large-cell lymphoma. Case Rep Med 2012;2012:1–6.10.1155/2012/968706 - DOI - PMC - PubMed
    1. Public Health England . COVID-19: investigation and initial clinical management of possible cases, 2020. Available: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initi... [Accessed 18 Apr 2020].

MeSH terms