Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2020; 8(7): 1265-1270
Published online Apr 6, 2020. doi: 10.12998/wjcc.v8.i7.1265
Atypical presentation of SARS-CoV-2 infection: A case report
Rui-Lin Li, Shu-Guang Chu, Yu Luo, Zhen-Hao Huang, Ying Hao, Cheng-Hui Fan
Rui-Lin Li, Yu Luo, Zhen-Hao Huang, Ying Hao, Cheng-Hui Fan, Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
Shu-Guang Chu, Department of Medical Imaging, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
Author contributions: Li RL conceived and designed the study; Chu SG carried out the literature search and provided the figures; Fan CH revised the manuscript for important intellectual content; all authors read and approved the manuscript for publication.
Supported by the National Natural Science Foundation of China, No. 81801379; Top-level Clinical Discipline Project of Shanghai Pudong District, No. PWYgf2018-02.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cheng-Hui Fan, MA, Attending Doctor, Department of Cardiology, East Hospital Affiliated to Tongji University, No. 1800 Yuntai Road, Pudong New Area, Shanghai 200123, China. fchman@163.com
Received: February 17, 2020
Peer-review started: February 17, 2020
First decision: March 5, 2020
Revised: March 6, 2020
Accepted: March 27, 2020
Article in press: March 27, 2020
Published online: April 6, 2020
Processing time: 48 Days and 20.7 Hours
Abstract
BACKGROUND

The first case of pneumonia subsequently attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, Hubei Province on December 8, 2019. The symptoms included fever, coughing, and breathing difficulties. A few patients with this infection may only have atypical symptoms, which could lead to a misdiagnosis and subsequently further facilitate the spread of the virus.

CASE SUMMARY

A 74-year-old female patient complained of severe diarrhea. She did not have fever, coughing, or breathing difficulties. A physical examination revealed no obvious positive signs. The patient had been hypertensive for more than 10 years. Her blood pressure was well controlled. On January 9, 2020, the patient’s son visited a colleague who was later confirmed positive for SARS-CoV-2 and his first close contact with our patient was on January 17. The patient was first diagnosed with gastrointestinal dysfunction. However, considering her indirect contact with a SARS-CoV-2-infected individual, we suggested that an atypical pneumonia virus infection should be ruled out. A computed tomography scan was performed on January 26, and showed ground-glass nodules scattered along the two lungs, suggestive of viral pneumonia. Given the clinical characteristics, epidemiological history, and examination, the patient was diagnosed with coronavirus disease-2019 (COVID-19).

CONCLUSION

Our patient had atypical symptoms of COVID-19. Careful acquisition of an epidemiological history is necessary to make a correct diagnosis and strategize a treatment plan.

Keywords: SARS-CoV-2; COVID-19; Pneumonia; Ground-glass opacity; Atypical symptoms; Diarrhea

Core tip: Coronavirus disease-2019 (COVID-19) symptoms include fever, coughing, and breathing difficulties. However some patients may only have atypical symptoms, which can lead to a misdiagnosis and further facilitate the spread of the virus. We here report a case of a 74-year-old patient with atypical symptoms, who was later diagnosed with COVID-19.