Question normal

Tariq Kewan and Ashraf Almomani

Case Presentation:
On March 16, 2020, a 63 year-old female patient with medical history of diabetes and hypertension presented to the emergency department (ED) with fever (102 F), productive cough, and purulent eye discharge that started ten days ago. She also reported shortness of breath, diarrhea and myalgia. She reported a travel history to middle east on December 2019 and contact with sick people in the plane . Also, she had recent travel history to New York city in the beginning of march.

Physical Exam:
In the ED patient was tachycardiac , tachypneic and hypoxic. Chest exam was clear. Eye exam showed bilateral redness with purulent eye discharge. Abdominal exam was benign.

Pertinent Laboratory values:
White blood cell count was normal (5.20) and she didn’t have lymphopenia. Sepsis lactate was checked and came back negative. Respiratory sputum culture didn’t grow any specific microorganisms. Assays to detect influenza viruses and a respiratory syncytial virus were all negative. A nasopharyngeal swab was positive for SARS-CoV-2 on real-time reverse transcription polymerase chain reaction (RT-PCR) assays on March 18, 2020. Blood culture drawn at the date of admission came back negative.

Pertinent images:
Computed topography (CT) scan of the chest didn’t reveal any consolidations or glass ground opacities (figure-1).

Treatment and Outcomes
Patient was started on levofloxacin and gentamycin eye drops. Also, she was supported with oxygen via nasal cannula. On day 2 of admission, patient improved significantly. She had low grade fever (100 F) overnight, oxygen saturation was 97% on room air and tachycardia resolved. Eye discharge almost resolved too. She was discharged home.

Lessons Learned:
Negative CT scan of the chest will not exclude COVID-19 and patients can present with upper respiratory symptoms and purulent conjunctivitis.