Significance of Differential Diagnosis for Febrile and Fatigued Patients in an Endemic Area During The COVID-19 Pandemic: Consideration of COVID-19, Brucellosis, and Crimean-Congo Hemorrhagic Fever

Abstract

Introduction: Brucellosis and Crimean-Congo Hemorrhagic Fever (CCHF) are diseases that can present with similar clinical and laboratory findings to those of COVID-19, leading to misdiagnosis or confusion by visiting multiple departments. This can delay diagnosis and increase the risk of nosocomial transmission in the case of CCHF. Although misdiagnosis of Brucellosis and CCHF, and even a case of coinfection have been reported in the literature, no case report mentioning CCHF and Brucellosis coinfection hospitalized with the pre-diagnosis of COVID-19 was found. Case Report: A 35-year-old female patient presented to the emergency service with complaints of fever and fatigue. The patient was evaluated in the emergency triage and was taken to the area where COVID-19 pre-diagnosed patients were being examined. A thorax computed tomography (CT) without intravenous contrast usage was reported as normal, and the patient was discharged after being informed about COVID-19 transmission routes. The patient re-applied to the emergency service with complaints of fever, fatigue, headache, and myalgia four days later. The laboratory findings showed a white-cell count of 1600/mm³, haemoglobin of 12.8 g/liter, platelet of 146000/mm³, urea of 21.5 mg/dl, creatinine of 0.81 mg/dl, alanine aminotransferase (ALT) of 134 U/liter, aspartate aminotransferase (AST) of 303 U/liter, lactate dehydrogenase (LDH) of 714 U/liter, creatine kinase (CK) of 1796 U/liter, C-reactive protein (CRP) of 3 mg/liter, D-dimer of 2000 µg/liter, and a thorax CT showed minimal ground-glass opacity. The patient was hospitalized with a preliminary diagnosis of COVID-19 by the chest diseases clinic. Conclusion: A patient with Brucellosis and CCHF coinfection was hospitalized with a preliminary diagnosis of COVID-19. This case highlights the importance of considering other diseases with similar clinical and laboratory findings in endemic regions of Brucellosis and CCHF to avoid misdiagnosis and delay in treatment. Early diagnosis and appropriate management are crucial for improving patient outcomes and preventing nosocomial transmission.