Coronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19.

Abstract

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 2 PreviousNext Case SeriesFree AccessPulmonary ImagingCoronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19Elisa Pianura, Federica Di Stefano , Massimo Cristofaro, Ada Petrone, Nicoletta Fusco, Fabrizio Albarello, Daniele Lapa, Stefania Cicalini, Paolo Campioni, Vincenzo SchininàElisa Pianura, Federica Di Stefano , Massimo Cristofaro, Ada Petrone, Nicoletta Fusco, Fabrizio Albarello, Daniele Lapa, Stefania Cicalini, Paolo Campioni, Vincenzo SchininàAuthor AffiliationsFrom the IRCCS National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Via Portuense 292, Rome 00149, Italy.Address correspondence to F.D.S. (e-mail: [email protected]).Elisa PianuraFederica Di Stefano Massimo CristofaroAda PetroneNicoletta FuscoFabrizio AlbarelloDaniele LapaStefania CicaliniPaolo CampioniVincenzo SchininàPublished Online:Apr 23 2020https://doi.org/10.1148/ryct.2020200162MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In A 74-year-old woman, residing in Rome, was admitted on March 4, 2020, with fever and dry cough for 5 days. She had an epidemiologic link with her sister, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratorial studies revealed elevated C-reactive protein and normal white cell count with neutrophilia. Chest CT studies obtained at admission showed multiple ground-glass opacities in both upper and left lower lobes, with small pleural effusions (Fig 1a). The patient was negative for SARS-CoV-2 on three polymerase chain reaction (PCR) nasopharyngeal swab tests. Serological tests for SARS-CoV-2 were also negative. A subsequent analysis for other respiratory viruses was positive for human coronavirus HKU1 (HKU1-CoV), and follow-up CT performed after 2 weeks of therapy showed almost complete radiologic resolution (Fig 1b).Figure 1a: Images in 74-year-old woman with HKU1 coronavirus pneumonia. (a) CT scan performed at admission shows a large area of peripheral ground-glass opacity (arrow) in the lower left lobe and small pleural effusions (star). (b) The CT scan performed after 14 days shows almost complete resolution of the imaging findings.Figure 1a:Download as PowerPointOpen in Image Viewer Figure 1b: Images in 74-year-old woman with HKU1 coronavirus pneumonia. (a) CT scan performed at admission shows a large area of peripheral ground-glass opacity (arrow) in the lower left lobe and small pleural effusions (star). (b) The CT scan performed after 14 days shows almost complete resolution of the imaging findings.Figure 1b:Download as PowerPointOpen in Image Viewer Although chest CT has been used for diagnosing coronavirus disease 2019 (COVID-19) (Fig 2), it relies on relatively nonspecific signs, such as multifocal and peripheral ground-glass opacities, consolidations, and crazy paving, which can be also found in other viral pneumonias (1–3). We illustrate a case of HKU1-CoV pneumonia, a novel group 2 coronavirus discovered in January 2004, which has been also associated with community-acquired pneumonia (4). Given the pandemic setting of COVID-19, the current case underscores the confirmatory role of PCR and the need for considering alternative diagnoses, especially when the full clinical, laboratorial, and radiologic picture does not fit into the most common presentation. Noticeably, neutrophilia and pleural effusions have been infrequently seen at the initial presentation of COVID-19 (5).Figure 2a: Images in patient with coronavirus disease 2019 (COVID-19) pneumonia. (a, b) Typical CT aspect of COVID-19 pneumonia: initial phase of disease with areas of ground-glass opacity peripherally (arrow in a); severe phase of disease with diffuse crazy paving pattern (arrow in b). Pleural effusions are absent.Figure 2a:Download as PowerPointOpen in Image Viewer Figure 2b: Images in patient with coronavirus disease 2019 (COVID-19) pneumonia. (a, b) Typical CT aspect of COVID-19 pneumonia: initial phase of disease with areas of ground-glass opacity peripherally (arrow in a); severe phase of disease with diffuse crazy paving pattern (arrow in b). Pleural effusions are absent.Figure 2b:Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: E.P. disclosed no relevant relationships. F.D.S. disclosed no relevant relationships. M.C. disclosed no relevant relationships. A.P. disclosed no relevant relationships. N.F. disclosed no relevant relationships. F.A. disclosed no relevant relationships. D.L. disclosed no relevant relationships. S.C. disclosed no relevant relationships. P.C. disclosed no relevant relationships. V.S. disclosed no relevant relationships.AcknowledgmentsCOVID 19 INMI Study Group.Author ContributionsAuthor contributions: Guarantors of integrity of entire study, E.P., F.D.S., M.C., A.P., N.F., F.A., P.C., V.S.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, E.P., F.D.S., M.C., A.P., N.F., F.A., D.L., P.C., V.S.; clinical studies, E.P., F.D.S., M.C., A.P., F.A., D.L., S.C., P.C., V.S.; experimental studies, E.P., F.D.S., M.C., A.P., F.A., D.L., P.C.; statistical analysis, E.P., F.D.S., M.C., A.P., F.A., P.C.; and manuscript editing, E.P., F.D.S., M.C., A.P., N.F., F.A., S.C., P.C., V.S.Keywords: Adults and Pediatrics, CT, Lung, Thorax Authors declared no funding for this work.