[Thoracolumbar back pain as the leading symptom of a marked COVID-19 pneumonia]. / Thorakolumbaler Rückenschmerz als führendes Symptom einer ausgeprägten COVID-19-Pneumonie.

ABSTRACT

HISTORY A 49-year-old male patient visited the surgical outpatient clinic with new onset low back pain. The pain was increasing for nine days and he did not have any signs of a respiratory infection, in particular neither fever nor cough. INVESTIGATIONS During the further examination and unclothing, mild dyspnea was apparent. According to the patient, the dyspnea was also progressive in the last days but would not affect everyday life. Furthermore, the patient reported a significant and unintended weight loss. Outpatient chest X-ray revealed bilateral, peripheral, fine-speckled infiltrates that became increasingly confluent. Polymerase chain reaction analysis of the nasopharyngeal swab was positive for SARS-CoV-2 (wild type). TREATMENT AND COURSE Due to progressive dyspnea, the patient was referred to inpatient treatment within the day, where he rapidly developed severe acute respiratory failure. To provide respiratory support, a combined intermittent non-invasive ventilation and nasal high flow-therapy was started. Moreover, a probatory antiviral therapy with remdesivir was initiated. Since a bacterial superinfection was suspected, additional antibiotic therapy was ordered. After 13 days of inpatient treatment, the patient was discharged. The low back pain receded completely during inpatient treatment without any specific therapy. CONCLUSIONS: Low back pain can be a symptom of COVID-19. In our case report, it was the only complain that led to the outpatient consultation. Even though back pain is a very common symptom in everyday practice, one should keep unusual causes in mind.