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Postgrad Med J ; 96(1137): 392-398, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-596194

ABSTRACT

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Delayed Diagnosis/prevention & control , Diagnostic Errors/prevention & control , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Cardiovascular Diseases/virology , Coronavirus Infections/immunology , Coronavirus Infections/virology , Cytokine Release Syndrome/physiopathology , Cytokine Release Syndrome/virology , Delayed Diagnosis/statistics & numerical data , Diagnosis, Differential , Diagnostic Errors/statistics & numerical data , Diarrhea/virology , Dysgeusia/virology , Humans , Nervous System Diseases/virology , Olfaction Disorders/virology , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , SARS-CoV-2 , Virus Replication
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