COVID-19 Pneumonia or Hypereosinophilic Syndrome?

Hypereosinophilic syndromes (HESs) are a group of disorders characterized by pathological proliferation of eosinophils. Diagnostic criteria include eosinophil count of 1,500/mm3 or higher, presence of organ involvement and exclusion of other causes of eosinophilia for at least 6 months. A 69-year-old male patient was referred to the pandemic clinic with a preliminary diagnosis of coronavirus disease 2019 (COVID-19) with fever and dyspnea. Computed tomography (CT) was compatible with COVID-19, nasopharyngeal swab polymerase chain reaction (PCR) was negative for two times. He had 20,000/mm3 eosinophilia and retrospective examinations showed that he have had eosinophilia for more than 1 year. Platelet-derived growth factor receptor alpha (PDGFRα) resulted positively. After starting parenteral methylprednisolone with a dose of 1 mg/kg, he was discharged with oral maintenance therapy. In outpatient follow-up, it was observed that eosinophilic pneumonia completely regressed. HES may occur with multiple system and organ involvement and findings. In the differential diagnosis of patients presenting with heart failure, pulmonary involvement and eosinophilia, HES must definitely be considered.

A new parameter in COVID-19 pandemic: initial lactate dehydrogenase (LDH)/Lymphocyte ratio for diagnosis and mortality.

BACKGROUND: COVID-19 (Coronavirus Disease-2019) is a pandemic disease, infecting more than 26.5 million people. Since there is no specific and effective treatment; early diagnosis and optimal isolation of the patient are of vital importance. Real-time polymerase chain reaction-based (RT-PCR) analyses do not achieve sufficient sensitivity in the diagnosis of the disease. METHODS: The data from 2217 patients diagnosed as COVID-19 between March 2020 and June 2020 and hospitalized or discharged with home isolation were retrospectively analyzed. Demographic data, comorbidities, PCR results, initial computed tomography (CT), laboratory values, Lactate Dehydrogenase (LDH)/Lymphocyte ratio, initial treatments and last status were recorded. The diagnostic sensitivity of LDH/Lymphocyte ratio, which is the main purpose of the study, was analyzed statistically. RESULTS: In order to test the effectiveness of LDH/Lymphocyte ratio for COVID-19 for diagnostic purposes, CT results were considered as gold standard. The area under the curve (AUC) was found to be 0.706 (p < 0.001; cut-off > 0.06) (Sensitivity: 76.4, specificity: 59.60). For the evaluation of LDH/Lymphocyte ratio in terms of survival, AUC was found to be 0.749 (p < 0.001; cut-off > 0.21) (Sensitivity: 70.59, specificity: 73.88). CONCLUSION: Studies based on radiological findings have demonstrated that CT involvement has higher sensitivity. LDH/Lymphocyte ratio was analyzed in terms of diagnosis and mortality with using specific CT involvement as gold standard method which was found to be a more sensitive due to PCR false negativity; 0.06 and 0.21 were obtained as cut off values for diagnosis and mortality.