CoViD-19 misdiagnosis: A case report

ABSTRACT

Background: In the CoViD-19 era any ground glass opacity is associated to SARS-CoV-2 pneumonia. Description of the case A 33-year-old man is referred to the emergency department for cough and diarrhea. The patient's vital signs are notable for an oxygen saturation of 93% in RT. His heart rate and blood pressure are normal. He has cachexia, but the remainder of the physical examination findings were normal. A complete blood cell count reveals lymphopenia and anemia. A thoracic CT scan shows a bilateral ground glass opacity. Molecular swab for CoViD- 19 was positive with a high ct value. The patient is admitted to our Department for CoViD-19 pneumonia. He reports a long history of weight loss, weakness and diarrhea. His CRP, LDH and g-GT levels are elevated;remaining laboratory tests are all within normal limits. A peripheral blood smear shows rare schistocytes and activated lymphocytes. He is started to a large spectrum antibiotic therapy. The results of further workup for lymphopenia (HBV, HCV, HHV, Toxo, CMV and EBV, coprocolture, parasitological stool exam) are negative. The molecular swab for CoViD-19 is persistently negative as well as the serological test. A Candida albicans infection is found in the sputum colture. The HIV test results positive and a genotyping is detected. He starts with antiretroviral therapy and antifungal therapy with improvement of clinical status. Conclusions: The CT scan appearance in our patient was suggestive for SARS-CoV-2 infection, but the clinical history and laboratory findings directed our attention to different diagnosis and correct treatment.