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.