CT scan does not make a diagnosis of Covid-19: a cautionary
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Evocative symptoms and TDM chest scan do not make a diagnosis of COVID-19. Molecular biology test in mandatory for the diagnosis of SARS-CoV-2 infection. This case calls for caution on the differential diagnosis of COVID-19.

A 12-year old girl presented to our paediatrics department with exacerbation of febrile asthma. Both parents reported flu-like symptoms for the previous ten days, including fever, cough, anosmia and ageusia and upper respiratory infections were reported in relatives. The patient reported appearance of a rhinorrhoea and a cough three days earlier with asthenia and feeling of oppression without dyspnoea. Symptoms worsened over the following two days with breathing difficulties and fever. The patient had a history of asthma but reported no recent salbutamol intake.

The patient had fever, with a temperature of 38°C, heart rate of 128 bpm, oxygen saturation 97% in ambient air, and respiration rate of 22 breaths/min. Biological results showed a normal complete blood count, normal CRP, and neither electrolyte disorder nor kidney failure. Clinical examination found no mottling, a capillary refill time of <3s, no cyanosis, discrete chest indrawing, and diffuse expiratory wheezing.

Low dose TDM chest scan showed unilobar, perihilar patchy ground glass distribution. Whilst the appearance was not typical of Covid-19, which conventionally has bilateral involvement and peripheral distribution, the presentation was evocative of Covid-19 pneumonitis in the pandemic context.

RT-PCR assays of nasopharyngeal samples at admittance and 24 hours later, were negative for SARS-CoV-2. Multiplex PCR on rhynopharyngeal secretions was positive for Coronavirus 229E.

The patient responded favourably to treatment with 60 mg prednisolone and 5 mg salbutamol in aerosol every two hours, which was progressively spaced out. The fever did not return, although the productive cough remained, and the patient was discharged two days after admittance.

Source: https://www.ijidonline.com/article/S1201-9712(20)30703-7/fulltext?rss=yes
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