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.