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Case Report: COVID-19 with Bilateral Adrenal Hemorrhage
Jorge Álvarez-Troncoso1, Miriam Zapatero Larrauri2, M Dolores Montero Vega3
11Internal Medicine Department, La Paz University Hospital, Madrid, Spain.
The American Journal of Tropical Medicine and Hygiene
|July 20, 2020
Summary
This case study highlights a COVID-19 diagnosis in a patient presenting with severe symptoms, including adrenal hemorrhage. Early detection and understanding of atypical presentations are crucial for managing this viral illness.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Radiology
Background:
- A 70-year-old male presented with acute lower back pain, fever, and gastrointestinal symptoms.
- Initial presentation mimicked other conditions, complicating diagnosis.
Observation:
- Patient exhibited hypotension, hyponatremia, lymphopenia, and elevated inflammatory markers.
- Computed tomography revealed bilateral bronchopneumonia consistent with COVID-19 and acute bilateral adrenal hemorrhage.
Findings:
- Despite a negative nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR), serological tests (ELISA) for immunoglobulin G (IgG) and immunoglobulin M (IgM) were positive.
- The combination of clinical presentation, imaging findings, and serology confirmed a diagnosis of COVID-19.
Implications:
- Atypical presentations of COVID-19, such as adrenal hemorrhage, require a high index of suspicion.
- Adrenal insufficiency secondary to hemorrhage can contribute to the severity of illness in COVID-19 patients.
- This case underscores the importance of considering serological testing in cases with high clinical suspicion despite negative RT-PCR results.
