Clinical Course of COVID-19 in Identical Twins

The rapid outbreak of coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to infection with variable clinical presentations and a wide clinical spectrum. The disease was first reported in Wuhan, China in 2019 and has rapidly spread worldwide. Despite reports of dynamic changes in disease progression, clinical predictors of disease severity have been difficult to identify. The following case describing identical twins with laboratory confirmed COVID-19 who had very different disease courses. These patients resided in the same home and shared many of the same comorbidities, including type 2 diabetes mellitus, hypertension and morbid obesity. Although twin 1 had higher inflammatory markers, white blood cell (WBC) and an arguably more complicated medical history in comparison to their identical twin, the patient experienced a milder and shorter disease course. This case highlights the need for identifying proper disease markers and predictors early in the clinical course in order to direct future management guidelines and timely treatment.