key: cord-0800214-z13htmxu
authors: Ruiy, Walis; Hsu, Shih-Yung; Tsai, Hsien-Lung; Chen, Chen-Te; Tseng, Chih-Peng; Chen, Wei-Teing
title: COVID-19 Mimicking Dengue Fever with the Initial Manifestation of Retro-orbital Pain – a Rare Case
date: 2020-06-04
journal: J Formos Med Assoc
DOI: 10.1016/j.jfma.2020.05.039
sha: 38f89fe8828b3dcba4918ecbd26aa5a4d528b7bf
doc_id: 800214
cord_uid: z13htmxu

nan

Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). 1 Reports have demonstrated that most patients present with fever, fatigue, muscle pain, upper respiratory tract or intestinal symptoms. 2 While the outbreak of COVID-19 has resulted in more than 4 000 000 infected in worldwide, there is no report or case on the association of COVID-19 with orbital pain. 3 Herein, we report a rare case of a 62-year-old Taiwanese female initially presenting retro-orbital pain with fever, mimicking Dengue fever. The patient was quickly identified to have been infected by SARS-CoV-2 and was hospitalized on March 15, 2020.

On March 14, 2020, a female with a medical history of bronchial asthma disclosed that she had returned to Taiwan after a Philippines travelling from March 7 to March 14.

On March 12 th , the patient began to have bilateral retro-orbital pain, headache and low-grade fever after attending her family gathering party. Her younger brother simultaneously had fever, a dry cough, and muscle pain and was later confirmed to have a SARS-CoV-2 infection in the USA.

Upon arrival to Taiwan Taoyuan International Airport, nasal swab were taken for SARS-CoV-2 testing based on the symptom of low grade fever. The patient directly sought medical assistance at emergency department of a regional hospital.

Subsequently, laboratory data showed levels of aspartate aminotransferase of 78 U/L, alanine aminotransferase of 41 U/L, γ-glutamyl transferase of 105 U/L. Chest radiography showed no evidences of pneumonia ( Figure 1 ). Both Influenza PCR and Dengue virus ELISA had negative results. After evaluation, the patient was discharged and was advised to quarantine at home.

The following day, Taiwan Centers for Disease Control notified her the positive results of SARS-CoV-2 infection, and she was hospitalized in the negative pressure isolation room. On admission day 1 (March 15th), Hydroxychloroquine (200mg three times a day) was administered. On admission day 3, she had low grade fever, severe dry mouth and persistent eye pain. Treatment was altered to Lopinavir-Ritonavir (200mg/50mg/tab) twice a day. Following 7 day of this treatment, the retro-orbital pain slowly improved, while low grade fever was still persistent. Therefore, Lopinavir-Ritonavir was discontinued. On admission day 15, the patient's fever subsided. After the three times negative results of SARS-CoV-2 RT-PCR from nasal swab samples, she was then discharge on admission day 39.

Here, we reported a case of COVID-19 with fever, headache and retro-orbital pain after a week-long trip to the tropics or subtropics, which mimics the classic manifestation of dengue fever. 4, 5 

Initial rapid and proactive response for the COVID-19 outbreak-Taiwan's experience

Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance

Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19

Dengue in travelers

On arrival to emergency department, chest radiography showed normal heart size and no evidence of pneumonia