M408 AN UNUSUAL MISSED DIAGNOSIS OF MULTIFACETED CLINICAL CASE OF CORONAVIRUS DISEASE 2019 MIMICKING UNCONTROLLED ASTHMA

Abstract

A patient with progressive shortness of breath, dry cough, tightness of the chest, mimic uncontrolled asthma. A diagnosis of coronavirus disease 2019 (COVID-19) infection might be delayed if a chest CT scan is not done (after abnormality of chest X-ray), despite a negative nasopharyngeal swab test reverse transcription, polymerase chain reaction (RT-PCR) assay. A 68-year old female presented to us with progressive shortness of breath worsening over 12 days, a dry cough, and tightness of the chest. Her primary care diagnosed her with severe persistent asthma and prescribed an inhaled bronchodilator, corticosteroid, anticholinergic and montelukast with a course of oral corticosteroid. The patient came to our clinic due to the worsening of symptoms despite the step-up therapy for asthma. Physical examination revealed decreased airflow and bilateral rales in both lungs, blood pressure: 137/78, temperature 38.9 C, heart rate 109 per minute, oxygen saturation 90 %. The chest CT Scan showed multiple ground-glass opacities and the serological antibodies tests against SARS-COV-2 were found positive for immunoglobulin M (IgM) and immunoglobulin G (IgG), confirming the diagnosis of COVID-19. Various medical conditions may mimic uncontrolled asthma. Patients unresponsive to asthma treatment should be evaluated for the presence of an asthma mimic, in this case COVID-19 infection. A chest CT Scan should be performed on the patient with serological virus specific IgG and IgM antibodies against SARS-COV-2 to diagnosis COVID-19 despite the negativity of the RT-PCR assay. This case highlights the complexity and the multifaceted presentation of coronavirus disease 2019 (COVID-19).