Diagnostic challenges for severe infection with severe acute respiratory syndrome coronavirus 2 in pregnancy: a case...

Diagnosis of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) proved challenging during the initial waves of the pandemic owing to false-negative diagnostic tests. Maternal patients with conditions such as preeclampsia and thromboembolism presented with overlapping symptoms with coronavirus disease 2019.

A 44-year-old South Asian mother in the third trimester presented with respiratory symptoms and preeclampsia. Two successive rapid antigen tests for coronavirus disease 2019 were negative. Treatment was started for lower respiratory tract infection and suspected thromboembolism (with a therapeutic dose of enoxaparin). With worsening respiratory distress, a chest X-ray was performed, which suggested severe coronavirus disease 2019. A repeated rapid antigen test was found to be positive. She was started on intravenous dexamethasone. She underwent an emergency caesarean section following reversal of enoxaparin with protamine and delivered a healthy baby. The mother was transferred to a tertiary care center for advanced intensive care. She was intubated 24 hours later and received a single dose of intravenous tocilizumab owing to increasing ventilatory supports. A computed tomography pulmonary angiogram excluded pulmonary embolism. She was extubated on day 5 and discharged home on day 15. On follow-up, she was found to be devoid of long-term sequelae coronavirus disease 2019 at 1 year. The false-negative rapid antigen test for coronavirus disease 2019 presented a diagnostic challenge to clinicians, especially when further supportive radiological investigations were unavailable in a low-resource setting. Maternal coronavirus disease 2019 bore nonspecific symptoms of other pregnancy-related conditions, further complicating the diagnostic and therapeutic process.

Pandemics pose significant challenges to clinicians, particularly in the initial stages, owing to diagnostic difficulties. A high index of suspicion and early involvement of multidisciplinary teams may prove to be adjunctive to surrogate investigations.