80-year-old man with dyspnoea and bilateral groundglass infiltrates: an elusive case of COVID-19

BMJ Case Rep. 2020 May 27;13(5):e236069. doi: 10.1136/bcr-2020-236069.

Abstract

COVID-19 is a novel viral infection caused by severe acute respiratory syndrome-coronavirus-2 virus, first identified in Wuhan, China in December 2019. COVID-19 has spread rapidly and is now considered a global pandemic. We present a case of a patient with minimal respiratory symptoms but prominent bilateral groundglass opacities in a 'crazy paving' pattern on chest CT imaging and a negative initial infectious workup. However, given persistent dyspnoea and labs suggestive of COVID-19 infection, the patient remained hospitalised for further monitoring. Forty-eight hours after initial testing, the PCR test was repeated and returned positive for COVID-19. This case illustrates the importance of clinical vigilance to retest patients for COVID-19, particularly in the absence of another compelling aetiology. As COVID-19 testing improves to rapidly generate results, selective retesting of patients may uncover additional COVID-19 cases and strengthen measures to minimise the spread of COVID-19.

Keywords: pneumonia (respiratory medicine); respiratory system.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • Clinical Decision-Making
  • Clinical Laboratory Techniques / methods*
  • Coronavirus Infections / blood
  • Coronavirus Infections / complications
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / diagnostic imaging
  • Delayed Diagnosis
  • Dyspnea / etiology
  • Humans
  • Lung / diagnostic imaging*
  • Male
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / diagnostic imaging
  • SARS-CoV-2
  • Tomography, X-Ray Computed