Torun Serife, Karaman Irem
Department of Pulmonary Diseases, Konya Training and Research Hospital, Konya, Turkey.
School of Medicine, Bahcesehir University, Istanbul, Turkey.
Front Med (Lausanne). 2022 Mar 10;9:844609. doi: 10.3389/fmed.2022.844609. eCollection 2022.
Rheumatoid arthritis (RA) is a systemic inflammatory connective tissue disease that affects 1-2% of the population worldwide. Pulmonary manifestations including interstitial lung disease (ILD), airway disease, pleural and vascular disease can be seen in up to 30-40% of patients with RA, which are recognized as the second most frequent cause of death in RA patients. The simultaneous occurrence of COVID-19 in RA patients with or without ILD, and the similarities and differences between RA-related ILD and COVID-19 lung findings have been reported in the literature. However, there was no reported case on differentiation of clinical findings of a patient with RA exacerbation causing a new diagnosis of ILD during the pandemic conditions.
Here, we presented a patient with RA who was misdiagnosed as COVID-19 twice due to non-specific respiratory symptoms and ground-glass opacities observed in high-resolution CT. The misdiagnosis led to a delayed diagnosis of ILD and prolonged pulmonary symptoms.
Clinicians must critically review patients throughout the diagnostic workup by thinking other diseases besides COVID-19, particularly in the absence of a confirmatory result. The link between ILD or ILD exacerbation and COVID-19 remains to be determined. While research continues in the field, it is important to consider the importance of COVID-19 in cases of ILD exacerbation, and vice versa.
Distinguishing lung imaging findings of COVID-19 from ILD is a major concern. Even though the primary manifestation of COVID-19 consists of respiratory symptoms, clinicians should be vigilant for other common conditions having the same symptoms. Clinicians should carefully distinguish a differential diagnosis between COVID-19 and a flare of rheumatic disease.
类风湿关节炎（RA）是一种全身性炎症性结缔组织疾病，全球1%-2%的人口受其影响。肺部表现包括间质性肺疾病（ILD）、气道疾病、胸膜和血管疾病，在高达30%-40%的RA患者中可见，被认为是RA患者第二常见的死亡原因。RA患者无论有无ILD合并感染新型冠状病毒肺炎（COVID-19），以及RA相关ILD与COVID-19肺部表现的异同，已有文献报道。然而，在大流行期间，尚无关于RA病情加重导致新诊断ILD的患者临床表现鉴别诊断的报道病例。
在此，我们报告了一名RA患者，因高分辨率CT中出现非特异性呼吸道症状和磨玻璃影，两次被误诊为COVID-19。误诊导致ILD诊断延迟和肺部症状延长。
临床医生在整个诊断检查过程中必须严格审查患者，考虑COVID-19以外的其他疾病，特别是在没有确诊结果的情况下。ILD或ILD加重与COVID-19之间的联系仍有待确定。虽然该领域的研究仍在继续，但在ILD加重病例中考虑COVID-19的重要性很重要，反之亦然。
区分COVID-19与ILD的肺部影像学表现是一个主要问题。尽管COVID-19的主要表现为呼吸道症状，但临床医生应警惕具有相同症状的其他常见疾病。临床医生应仔细鉴别COVID-19与风湿性疾病发作的鉴别诊断。
