Covid Case

A 35-year-old nurse was 27 weeks pregnant (G4 P1+2) with a history of latent tuberculosis treated with rifampicin, isoniazid, and pyridoxine in 2011 and no other comorbidities. She has never smoked and has never been exposed to passive smoking. 

She is a nurse for COVID-19 patients on the acute medical wards and had been self-isolating at home with her family since the onset of her symptoms. She had not been taking any regular medications and had no recent travel history.

 

Presenting Symptoms

The patient presented to the emergency department with a 9-day history of fever, dry cough, sore throat and breathlessness. 

 

Examination

On 2 L/min of oxygen via nasal cannula, her respiratory rate was 21 breaths per minute, with oxygen saturation (SpO2) of 95%. She had a tachycardic heart rate of 111 beats per minute, a blood pressure of 103/70 mm Hg, and a temperature of 35.9°C. On chest auscultation, there were bilateral basal crepitations. A gravid uterus was discovered during a systemic examination, but everything else was normal.

 

Investigations

Routine blood tests revealed that the patient had a mild lymphopenia of 0.93109/L (normal range >1) and an elevated C reactive protein of 117 mg/L (normal range 5), with no other significant abnormalities. On admission, an anterio-posterior chest radiograph revealed bilateral mid and lower zone consolidation, consistent with COVID-19 infection.

 

Diagnosis

She was managed for likely COVID-19 infection and admitted under general internal medicine based on her history, blood test results, and chest radiograph findings. Oral and nasopharyngeal swabs taken during admission for viral PCR yielded a positive result for COVID-19, confirming this diagnosis.