Question normal

Date of Presentation: Feb 10th 2020

Case presentation:
A 67 years old male developed fever since Jan/21/2020, with a maximum body temperature of 39.0℃. The fever mainly took place in the morning, with chills, cough, and a little white sputum. He also complained about headache, dizziness, muscle aches, and palpitations. He then went to the Zhongnan Hospital of Wuhan University on Jan/25/2020, the chest X-ray on Jan/25/2020 indicated heavy shadows in both lung hilars. According to the 3rd edition of “Diagnosis and Treatment Plan for Covid-19 of China”, he was diagnosed of suspect infected case of covid-19. He was given acyclovir (350mg, q8h, i.v.) and moxifloxacin (400mg, qd, i.v.) and oxygen inhalation through nasal tube. The influenza A virus test, influenza B virus test and avian influenza test on Jan/29/2020 and Jan/30/2020 were all negative. On Jan/29/2020, the lung CT scan indicated bilateral viral pneumonia, swollen lymph nodes in mediastinum and bilateral hilars; and the throat swab covid-19 rt-PCR test was positive (sample taken on Feb/3/2020). He was ultimately diagnosed of covid-19. I

Past medical history:
Medical history of stomach illness for 10 years; No hepatitis or tuberculosis; No allergy to any drug or food;

Physical exam:
At admission: Temperature 37.2℃, pulse 112 times/min, respiratory rate 24 times/min, blood pressure 127/94 mmHg, SpO2 96% (under oxygen inhalation through nasal tube, 3L/min).

Labs tests and Imaging:
Before Admission:
Jan/25/2020, Zhongnan Hospital of Wuhan University, Chest X-Ray: heavy shadows in both lung hilars; white blood cell count: 5.70 109/L (normal range 3.50-9.50 109/L), lymphocyte: 2.10 109/L (normal range 1.10-3.20 109/L), LYM%: 37.1% (normal range 20.0-50.0).
Jan/29/2020, Zhongnan Hospital of Wuhan University, CRP: 42.8 mg/L↑ (normal range 0-10 mg/L); influenza A virus test, influenza B virus test, avian influenza test: all negative;
Jan/30/2020, Zhongnan Hospital of Wuhan University, influenza A virus test, influenza B virus test, avian influenza test: all negative;
Jan/29/2020, Zhongnan Hospital of Wuhan University, lung CT scan: bilateral viral pneumonia, swollen lymph nodes in mediastinum and bilateral hilars; throat swab covid-19 rt-PCR test (sample taken on Feb/3/2020): positive.
After admission:
Feb/10/2020, white blood cell count: 4.32 109/L (normal range 3.50-9.50 109/L), lymphocyte: 1.36 109/L (normal range 1.10-3.20 109/L), LYM%: 31.5% (normal range 20.0-50.0)
Feb/16/2020, CRP: 1.60 mg/L (normal range 0-10 mg/L).
Feb/20/2020, covid-19 rt-PCR test: negative.
Feb/21/2020, influenza A virus IgM test: positive.
Feb/24/2020, covid-19 rt-PCR test: negative.
Feb/25/2020, lung CT scan: bilateral viral pneumonia, improved since last scanning.

Treatment and outcome:
The patient was diagnosed of covid-19 since admission. Antivirus treatment (arbidol, 200mg, 3/d, p.o., 10 days), traditional chinese medicine (Lianhuaqingwen capsule, p.o.), and supportive treatment was given, along with oxygen inhalation through nasal tube (3L/min).
The patient was later diagnosed of both covid-19 and influenza type A on Feb/21/2020.
The patient gradually recovered since admission.
According to the 6th edition of “Diagnosis and Treatment Plan for Covid-19 of China”: the throat swab rt-PCR tests for covid-19 were negative twice, consecutively; and the lung CT scan indicated obvious improvement of infection. So, the patient had met the discharge criteria and was discharged on Feb/25/2020.

Lessons learned:
Covid-19 and influenza type A can be both diagnosed for one same patient. Patients can get both even in recent one months. Covid-19 and influenza type A are not mutually-exclusive.