Question normal

Department of Radiology
Richmond University Medical Center

Sukhdev Singh, Zohaib Khan, Jahinover Mazo M.D., Abhiram Nagaraj M.D., Peter Mena M.D.

Patient in his 50’s with obesity, presented to the ED with a 1 week history of fever, chills, myalgia and cough of 1 week duration. Patient was seen as outpatient by PCP 1 week prior for similar symptoms and was prescribed Zithromax. He endorsed subsequent worsening of symptoms prompting evaluation in the ED. Patient denied any sore throat, earache, vomiting, diarrhea, dysuria. He denied any contact with persons with similar symptoms or recent travel history.

PHYSICAL EXAM:

In the ED patient was febrile with a temperature of 103.1. Other vitals were stable with a BP 134/83, R22 and P94.

LABS:

CBC revealed a platelet count of 87k and a WBC of 3.5k. Serology with RT-PCR was negative for Influenza A, Influenza B and RSV. Blood cultures were collected with no growth to date. On hospital day 2 COVID-19/SARS-CoV-2 results returned positive.

IMAGING:

CXR: Bilateral pneumonic infiltrates
CT: Multiple bilateral small areas of ground glass opacities scattered throughout the posterior lower lung, suggesting an atypical/viral pneumonia. No pleural effusions or mediastinal adenopathy.

TREATMENT & OUTCOME:

In the ED Patient treated with IVF, Ofirmev 1000 mg IV, and Levofloxacin 750 mg in D5W.
He was placed in isolation with contact and droplet precaution pending COVID-19 results. Patient was admitted to medical service for management of CAP and r/o COVID-19 pneumonia. He was started on Ceftriaxone 1g IV and Azithromycin 500 mg IV x1 day. On day 2 of admission patients reported symptomatic improvement. Given his improvement, the patient was discharged on day 2 with instructions to self isolate for 14 days. He was prescribed a regimen of Hydroxycholoquinolone 400mg PO x 1 and 200mg PO q12h x 7 days, Azithromycin 500mg PO x 1 and 250mg PO qd x 4 days and Augmentin 875mg PO q12h x 8 days.

LESSONS LEARNED:

In this case, the patient was leukopenic on presentation, consistent with other reports of COVID-19 patients with imagining confirmed pulmonary involvement. In addition this patient was obese with no prior medical history and thrombocytopenia was seen on labs the link of both with COVID-19 which remain uncertain but may warrent further investigation.