Livrieri Francesco, Ghidoni Giulia, Piro Roberto, Menzella Francesco, Cavazza Alberto, Lazzaretti Claudia, Massari Marco, Montanari Gloria, Fontana Matteo, Facciolongo Nicola Cosimo
Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia 42123, Italy.
Pathology Unit, Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia 42100, Italy.
Int Med Case Rep J. 2020 Nov 2;13:563-567. doi: 10.2147/IMCRJ.S277474. eCollection 2020.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing a massive outbreak throughout the world. In this period, diseases other than coronavirus disease (COVID-19) have not disappeared; however, it is hard for doctors to diagnose diseases that can mimic the clinical, radiological, and laboratory features of COVID-19, especially rare lung diseases such as acute eosinophilic pneumonia (AEP). We report the clinical case of a young patient who presented to the Emergency Department with respiratory failure and clinical symptoms, radiological aspects, and blood tests compatible with COVID-19; two swabs and a serology test for SARS-CoV-2 were performed, both resulted negative, but the respiratory failure worsened. Peripheral eosinophilia guided us to consider the possibility of a rare disease such as AEP, even if radiology findings were not pathognomonic. Therefore, we decided to perform a flexible bronchoscopy with bronchoalveolar lavage (BAL) at the lingula, which showed the presence of eosinophilia greater than 40%. As a consequence, we treated the patient with high-dose corticosteroids that completely resolved the respiratory symptoms. This case report highlights the difficulty of making alternative diagnoses during the COVID-19 pandemic, especially for rare lung diseases such as AEP, which may have initial characteristics similar to COVID-19.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）正在全球引发大规模疫情。在此期间，除冠状病毒病（COVID-19）之外的其他疾病并未消失；然而，医生很难诊断出可能模仿COVID-19临床、影像学和实验室特征的疾病，尤其是像急性嗜酸性粒细胞性肺炎（AEP）这样的罕见肺部疾病。我们报告了一名年轻患者的临床病例，该患者因呼吸衰竭及与COVID-19相符的临床症状、影像学表现和血液检查结果就诊于急诊科；进行了两次SARS-CoV-2拭子检测和一次血清学检测，结果均为阴性，但呼吸衰竭却加重了。外周血嗜酸性粒细胞增多促使我们考虑诸如AEP这种罕见疾病的可能性，即便影像学表现并不具有特异性。因此，我们决定在舌叶进行经支气管镜肺活检（BAL），结果显示嗜酸性粒细胞比例超过40%。于是，我们用大剂量皮质类固醇对该患者进行治疗，患者的呼吸道症状完全缓解。本病例报告凸显了在COVID-19大流行期间做出其他诊断的困难，尤其是对于像AEP这样可能具有与COVID-19相似初始特征的罕见肺部疾病。
