Non-pulmonary manifestations of coronavirus disease 2019 (COVID-19): case report

Abstract

: Doctors from various specialties across the world are faced with the management of coronavirus disease 2019 (COVID-19). The typical presentation is one of viral pneumonia, with a large spectrum of disease severity. Increasingly, extra-pulmonary manifestations are being reported, often in those with significant pulmonary pathology. Here we discuss a novel presentation of COVID-19, with no pulmonary involvement and the challenges faced by clinicians in achieving the correct diagnosis. A previously fit and well 30-year-old female presented with gastroenteritis, pyrexias, myalgia, rashes, conjunctivitis, and myocarditis. There were no respiratory features, either from her history or clinical examination. Initial and subsequent reverse transcription polymerase chain reaction (RT-PCR) swabs were negative for severe acute respiratory failure coronavirus 2 (SARS-CoV-2), alongside normal appearances of her lungs on computed tomography scans. Her third and final COVID-19 RT-PCR swab was positive, just prior to transfer for her ongoing myocarditis management, at a specialist cardiac critical care. She went on to make a full recovery. Novel presentations of COVID-19 signify a new challenge to clinicians. Correct diagnosis is important for the patient, as well as staff safety. Atypical presentations often have non-specific clinical features, and so a strong index of suspicion, appropriate exclusion of differentials and a multi-disciplinary approach are needed.