CASE 16664 Published on 23.03.2020

COVID-19 in a young immunocompromised patient

Section

Chest imaging

Case Type

Clinical Cases

Authors

Jaime Alonso Sánchez, Alicia Castelo Loureiro, Julia García Prieto, Albert Domingo Senan, Elena Martínez Chamorro

Hospital Universitario 12 de Octubre, Madrid, Spain

Patient

29 years, female

Categories
Area of Interest Lung ; Imaging Technique CT
Clinical History

A 29-year-old immunocompromised female patient with a 3-day history of cough and fever. Past medical history includes severe ulcerative colitis treated with Tofacitinib. The patient was admitted to the hospital ward and discharged one week after admission with complete recovery.

Imaging Findings

Chest X-ray: Increase of parenchymal opacity in right lower lobe.

Chest CT with contrast: No pulmonary emboli. Multilobar, multifocal and bilateral confluent ground-glass opacity (some of them are rounded) and overimposed consolidation in inferior right lobe. Subtle septal thickening in right lobe with crazy paving appearance. No signs of pleural or pericardial effusion.

Discussion

Our case presents a 29-year-old immunocompromised female patient with a 3-day history of cough and fever. Chest X-ray and positive SARS-CoV-2 RT-PCR confirmed COVID-19 pneumonia. The patient is in a immunocompromised state as a result of severe ulcerative colitis treated with Tofacitinib 10 mg/12 h. She was admitted to the hospital ward and a CT-scan of the chest was performed to rule out life-threatening complications due to her respiratory distress.

She recovered well after treatment with hidroxicloroquine and discharged one week after initial admission with complete resolution of the symptoms. Lopinavir/Ritonavir and Tocilizumab were contraindicated as they may produce diarrhoea and ulcerative colitis flare-up.

COVID-19 is a pandemic caused by SARS-CoV-2, a new coronavirus, which was first reported in China. Cough and fever seem like the most common symptoms but the disease could be fatal in patients with multiple comorbidities [1].

The diagnosis of COVID-19 could be challenging because the symptoms can overlap with other diseases such as influenza or H1N1. Radiology may play a role since the CT-scan is very sensitive [2] in initial stages of the disease and X-ray findings could be very subtle. A prompt diagnosis could help clinicians to anticipate complications in patients at risks.

Typical CT findings include unilateral or bilateral ground-glass opacities (often rounded morphology) with or without consolidation in early phases and confluent ground-glass opacities with superimposed consolidation and septal thickening (crazy pacing) in late phases [3, 4].

Written informed patient consent for publication has been obtained.

Differential Diagnosis List
COVID-19
Adenovirus
SARS
MERS
Final Diagnosis
COVID-19
Case information
URL: https://www.eurorad.org/case/16664
ISSN: 1563-4086