1Internal Medicine Department, La Paz University Hospital, Madrid, Spain.
2Endocrinology Department, La Paz University Hospital, Madrid, Spain.
Am J Trop Med Hyg. 2020 Sep;103(3):1156-1157. doi: 10.4269/ajtmh.20-0722.
A 70-year-old Dominican Republic man presented with lower back pain for 10 days. Fifteen days before pain onset, he had low-grade fever, chills, and asthenia, and 4 days before admission, he had constipation, malaise, generalized weakness, anorexia, nausea, and vomiting. On admission, the patient was afebrile and hypotensive, with a heart rate of 105 and an oxyhemoglobin saturation on room air of 95%. Hyponatremia, lymphopenia, elevated C-reactive protein, and ferritin were observed in complementary tests. Computed tomography (CT) scan showed findings consistent with COVID-19 bilateral bronchopneumonia, and an increase in size and blurring (loss of the Y shape) of both adrenals indicative of acute bilateral adrenal hemorrhage. The patient tested negative by reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal swab, yet positive for IgG and IgM by ELISA, suggesting COVID-19 diagnosis.
一位 70 岁的多米尼加共和国男性因下背部疼痛就诊，病程 10 天。在出现疼痛前 15 天，他有低热、寒战和乏力，在入院前 4 天，他有便秘、不适、全身无力、食欲不振、恶心和呕吐。入院时，患者体温正常且血压低，心率为 105 次/分，室温下血氧饱和度为 95%。补充检查发现低钠血症、淋巴细胞减少、C 反应蛋白和铁蛋白升高。计算机断层扫描（CT）显示符合 COVID-19 双侧支气管肺炎的结果，双侧肾上腺增大和模糊（Y 形消失）提示急性双侧肾上腺出血。患者的鼻咽拭子逆转录聚合酶链反应（RT-PCR）检测结果为阴性，但酶联免疫吸附试验（ELISA）检测 IgG 和 IgM 为阳性，提示 COVID-19 诊断。
