Diagnostic Challenge in a Sickle Cell Disease Patient with COVID-19

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Diagnostic Challenge in a Sickle Cell Disease Patient with COVID-19

Case Report

Jorge Rodrigues

Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal

Tiago Milheiro Silva

Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal

Ana Margarida Garcia

Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal

Eugénia Soares

Department of Radiology, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal

Maria João Brito

Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal

DOI: https://doi.org/10.25754/pjp.2022.21819

Abstract

Acute chest syndrome (ACS) is a life-threatening complication in sickle cell disease (SCD). Infections are frequently implied and like other viruses, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be a trigger. Additionally, due to their inflammatory status, they are considered a high-risk group for severe coronavirus disease 2019 (COVID-19). Pneumonia and ACS share clinical, laboratory and radiological features and may overlap, which makes their differential diagnosis especially challenging.

We describe a case of an adolescent with homozygous SCD (HbSS) that developed ACS in the context of COVID-19. With it, we intend to bring awareness to the potential role of imaging in the differential diagnosis and in establishing the best approach for the patient. Chest CT findings were suggestive of an alternative diagnosis to COVID-19 pneumonia and blood transfusion, fluid therapy, analgesics, antibiotics were administered with favorable outcome.