Case Reports
Case 1 is a 67-year-old man, with ischemic heart disease, diabetes
mellitus, hypertension, dyslipidemia. He presented with a three-day
history of dyspnea without preceding fever or respiratory complaints. He
had low grade pyrexia of 37.8°C but unremarkable pulmonary auscultation.
His initial chest radiograph was unremarkable (Figure 1A). Oropharyngeal
swab for SARS-CoV-2 real-time polymerase chain reaction (RT-PCR)
returned positive. In the two weeks preceding his symptom onset, he had
largely confined himself at home in compliance with nationwide measures
to curb the ongoing outbreak. His only household contact was his wife,
who had been asymptomatic. He developed fever of 38.7°C on his fourth
hospitalization day, associated with clinical deterioration. Repeat
chest radiograph showed interval development of bilateral mid-to-lower
zone air space changes suggestive of pneumonia (Figure 1B). He was given
lopinavir/ritonavir and his maximum oxygen requirement was 2 L/min via
nasal prongs during his ten-day hospitalization stay.
Case 2 is a 52-year-old female with poorly controlled diabetes mellitus,
hypertension and dyslipidemia. She presented with acute onset left flank
pain associated with dysuria, fever, chills and rigors, but no
respiratory symptoms. Clinical examination on presentation revealed
fever (40.6°C), tachycardia (pulse rate 120 beats/min) and left
costovertebral tenderness. Urine dipstick was positive for leucocytes
and nitrites, with subsequent urine culture growing Escherichia
coli . Procalcitonin was raised at 121.92 ug/L. She was screened for
SARS-CoV-2 RT-PCR via oropharyngeal swab in view of incidental right
lower zone opacities seen on chest radiograph (Figure 1C), as part of
our hospital’s SARS-CoV-2 pneumonia surveillance program. Results were
positive on two consecutive swabs, confirming the diagnosis of COVID-19.
Left perinephric fat stranding (Figure 1D) was seen on abdominal
computed tomography (CT) scan. Its basal lung views revealed patchy
ground glass consolidation (Figure 1E). She improved clinically without
need for supplemental oxygen. The diagnosis of COVID-19 would have been
missed had she presented prior to chest radiographic changes or if no
chest radiograph was performed.
Case 3 is a 49-year-old man without known medical history. He presented
with a five-day history of left breast lump, suggestive of an abscess.
He had no preceding fever, myalgia, headache, respiratory symptoms,
gastrointestinal symptoms, anosmia or dysgeusia. He was found to have
newly diagnosed diabetes mellitus. Admission chest radiograph was
unremarkable (Figure 1F). Bacterial culture of abscess aspirate grewStaphylococcus aureus . In view of an ongoing SARS-CoV-2 outbreak
in the dormitory where this patient had been staying, he was screened
for SARS-CoV-2 RT-PCR from an oropharyngeal swab, which returned
positive.