key: cord-0970500-bfz9tv8q
authors: Zhai, Lu-Lu; Xiang, Feng; Wang, Wei; Lun, Wu; Ye, Ling; Yao, Li-Chao; Tang, Zhi-Gang
title: Atypical presentations of coronavirus disease 2019 in a patient with acute obstructive suppurative cholangitis
date: 2020-05-21
journal: Clin Res Hepatol Gastroenterol
DOI: 10.1016/j.clinre.2020.05.003
sha: d05668a4c606369feac7dac56f7937d661866c26
doc_id: 970500
cord_uid: bfz9tv8q

Abstract During the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak in Wuhan, China, we experienced a case of SARS-CoV-2 infection with atypical presentations in a patient with acute obstructive suppurative cholangitis (AOSC), who was initially admitted with jaundice and fever. The patient had no other typical symptoms of COVID-19 such as cough, dyspnea, nausea, vomiting, abdominal pain and diarrhea except for fever, but her epidemiological history was clear. COVID-19 was finally confirmed by repeated viral nucleic acid testing, but her repetitive lungs CT imaging findings had been atypical. After endoscopic-related operations and antiviral treatment, the patient was subsequently recovered and discharged. This particular case is being reported to provide a reference and guidance for the diagnosis and management of COVID-19 in AOSC.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, which seriously threatens human health. Since the disease was first discovered from Wuhan, Hubei province, China in December 2019, the epidemic has rapidly spread to many countries around the world [1,2]. As of May 1, 2020, a total of 3,175,207 COVID-19 cases were confirmed globally, including 224,172 deaths [2] . Compared with SARS-CoV and MERS-CoV, SARS-CoV-2 has a lower fatality rate but is more contagious [3, 4] . After being exposed to the virus, patients infected with SARS-CoV-2 usually present with fever, respiratory symptoms, gastrointestinal symptoms, fatigue, or myalgia within 14-day incubation period [5] [6] [7] [8] [9] . Typical pulmonary CT imaging features of COVID-19 patients are patchy Chest CT showed that strip shadows still existed in the lungs, but which were significantly less than before (Figure 5 ). Since the patient was identified as a Although the patient had no other typical symptoms of COVID-19 except for fever when she came to the hospital, SARS-CoV-2 was spreading widely in Wuhan, China at that time, and the patient had been living in Wuhan. Accordingly, Pulmonary CT scanning and SARS-CoV-2 nucleic acid testing were performed to exclude COVID-19.

The first lungs CT revealed high-density strip shadows in both lower lung, which were not typical CT patterns of COVID-19 pneumonia. The first viral nucleic acid testing result was also negative. However, the pathophysiological changes of AOSC can cause impaired immune function. In addition, the patient is older and has underlying health conditions. These adverse factors make this patient is more vulnerable to SARS-CoV-2 than the general population. Therefore, the patient could not be completely excluded as COVID-19, and was safely and prudently classified as a suspicious case. shadows and interstitial changes, then developed into ground-glass opacities and infiltrates, and in severe cases even into pulmonary consolidation, but pleural effusion was rare [9] [10] [11] [12] . This patient has not shown the typical CT characteristics of COVID-19 pneumonia. It may be that early antiviral treatment blocked the pathological changes in the lungs. Chest CT showed high-density strip shadows of both lungs, which may be a secondary bacterial infection of lung injury caused by acute severe cholangitis.

In conclusion, we reported a case of COVID-19 with atypical presentations in an AOSC 

World Health Organization

Frequently asked questions about SARS

Middle East respiratory syndrome coronavirus (MERS-CoV)

Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multicenter study in Wenzhou city

Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study

Novel Coronavirus (COVID-19) Pneumonia: Serial Computed Tomography Findings

Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing

Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease

The authors declare that they do not have a conflict of interest.

Lu-Lu Zhai and Feng Xiang: drafting and editing of manuscript, acquisition of data.Wei Wang, Lun Wu, Ling Ye and Li-Chao Yao: editing of manuscript.Zhi-Gang Tang: analysis and interpretation of data, revision of manuscript.