key: cord-1022237-gmllk6d4
authors: Momenzadeh, Mahmud; Shahali, Hamze; Farahani, Azade Amirabadi
title: COVID-19 Suspection: A case report regarding a male emergency medical service pilot with newly diagnosed sarcoidosis
date: 2020-05-03
journal: Air Med J
DOI: 10.1016/j.amj.2020.04.014
sha: a3a1d5110406d431c2d3984e6c8ec736c02562d9
doc_id: 1022237
cord_uid: gmllk6d4

Abstract A 38-yr-old Emergency Medical Service Bell 214 male pilot with dry cough, fever, anorexia, fatigue and sweating for the past 3d, oral temperature 38°C, blood pressure 105/65 mm Hg, heart rate 94, respiratory rate 21, and pulse oximetry 93% on room air was suspicious for COVID-19. Surprisingly, RT-PCR was negative but bilateral hilar adenopathy was reported in his chest radiography as new challenge. Pathologic report of adenopathy biopsy was noncaseating sarcoidal type granulomas. Serologic tests shown serum ACE level of 58 nmol/mL/min. Bronchoalveolar lavage had CD4 to CD8 ratio of 3.68. All findings provide accurate sarcoidosis diagnosis and HRCT scan revealed Stage I pulmonary involvement. Due to pulmonary involvement, clinical manifestations, use of inhaled fluticazone, need more longer and accurate follow up and protect against COVID-19, he has been temporarily suspended until the final assignment.

With concerns about his health and spread of the virus, based on his clinical manifestations, aeromedical examiner suspected COVID-19, requested reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA (nasopharyngeal specimen), grounded and quarantines him with prescription of diphenhydramine and naproxen to follow up in the next 72h or sooner if worsening or new symptoms arise. Surprisingly, RT-PCR test was negative and the next choice with symptoms existence was chest radiography. Bilateral hilar adenopathy was reported, the diagnosis and treatment process has changed basically. Pathologic report of the specimen obtained from adenopathy biopsy was noncaseating sarcoidal type granulomas. Serologic tests shown serum Angiotensin Converting Enzyme (ACE) level of 58 nmol/mL/min.Bronchoalveolar lavage specimen had CD4 to CD8 ratio of 3.68. All findings provide accurate sarcoidosis diagnosis and High-resolution computed tomography (HRCT) scan revealed Stage I pulmonary involvement. After full investigations, he had no any other systemic involvement and treated with inhaled fluticazone. Due to pulmonary involvement, clinical manifestations, use of inhaled fluticazone, need more longer and accurate follow up and protect against COVID-19, he has been temporarily suspended until the final assignment.

Unfortunately, similar symptoms in different diseases may lead to misdiagnosis or delay in diagnosing important diseases which can cause irreparable personal and social harms as disability or death. After sufficient exposure to COVID-19 infected agents, symptoms present as fever, cough, fatigue, anorexia, shortness of breath, sputum production and myalgias [4] . Diagnosis requires detection of SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR). Detection is better in nasopharynx samples compared to throat samples [2] . COVID-19 presentations are very similar to acute sarcoidosis which is rare but is very troublesome disease for pilots and may be confusing lead to delay in treatment. Sarcoidosis more common in Caucasian population and typically has a spontaneous remission within 2yr [5] .Based on medical aviation regulations, due to high probability of brain, heart and lungs involvement and treatment complications, pilots with sarcoidosis need full systematic assessment and follow up with not allowance to fly until the follow up completion and therapy cessation. However, they have very low chance for return to flying, even with restrictions [6, 7] .

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