Li Rui-Lin, Chu Shu-Guang, Luo Yu, Huang Zhen-Hao, Hao Ying, Fan Cheng-Hui
Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China.
Department of Medical Imaging, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China.
World J Clin Cases. 2020 Apr 6;8(7):1265-1270. doi: 10.12998/wjcc.v8.i7.1265.
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.
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).
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.
2019年12月8日，湖北省武汉市出现了首例后来被归因于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的肺炎病例。症状包括发热、咳嗽和呼吸困难。少数感染该病毒的患者可能仅有非典型症状，这可能导致误诊并进而促进病毒的进一步传播。
一名74岁女性患者主诉严重腹泻。她没有发热、咳嗽或呼吸困难。体格检查未发现明显阳性体征。该患者患有高血压10余年，血压控制良好。2020年1月9日，患者的儿子拜访了一位同事，该同事后来被确诊为SARS-CoV-2阳性，他与我们这位患者的首次密切接触是在1月17日。该患者最初被诊断为胃肠功能紊乱。然而，考虑到她与一名SARS-CoV-2感染个体的间接接触，我们建议排除非典型肺炎病毒感染。1月26日进行了计算机断层扫描，显示两肺散在磨玻璃结节，提示病毒性肺炎。根据临床特征、流行病学史和检查结果，该患者被诊断为2019冠状病毒病（COVID-19）。
我们的患者有COVID-19的非典型症状。仔细询问流行病学史对于做出正确诊断和制定治疗方案至关重要。
