RESUMEN
Background: Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has spread globally becoming a pandemic. The clinical manifestations of COVID-19 vary from asymptomatic to symptomatic disease. Hematologic manifestation which is commonly found in COVID-19 patients is thrombocytopenia whereas thrombocytosis is rarely reported. Case Presentation: We report a case of a 55-year-old woman with one week history of fever which spike along the day, dry cough, anosmia, nausea, epigastric pain and loss of appetite. She lived in local transmission area. The patient was diagnosed as mild suspected COVID-19 and confirmed with nasopharyngeal and oropharyngeal swab test (positive result). On admission, the number of platelet count was within normal limit but progressively increased exceeding 1000 x109/L accompanied by worsening of the clinical condition. Interestingly, to our knowledge, no such case has ever been reported. In this study, we will discuss the possible mechanisms of its changes. Conclusions: COVID-19 can present with extreme thrombocytosis. Thus, monitoring the platelet count during hospitalization can be helpful for anticipating worsening conditions and progression of COVID-19.
RESUMEN
Early diagnosis is among the crucial measures to control the spread of SARS-CoV-2 infection. To date, reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for COVID-19 testing, but various factors can affect its performance leading to false negative results. Hereby we present a patient with a high clinical suspicion for COVID-19 and had multiple negative RT-PCR results over 5 days. A 22-year-old woman presented with fever, dry cough, nausea, myalgia, headache, and mild dyspnea. Eleven days before, she was in close contact with her father who had tested positive for COVID-19. RT-PCR on nasopharyngeal and oropharyngeal swabs were performed on day 8, 9, and 12 of illness which all came back negative even after she started having a worsening dyspnea and showing an increased lung opacity from radiographic findings on day 11 of illness. Interestingly, her rapid antibody test (VivaDiag™ COVID-19 IgM/IgG rapid test by VivaChek Biotech (HangZhou,China) was positive for anti-SARS-CoV-2 Ig M and Ig G. Due to the worsening condition, she was referred to a tertiary hospital where her RT PCR result was positive on day 13 of illness. After 28 days from her first symptom, she was discharged from the hospital with improved symptoms and chest X-ray. As conclusions, in patients with high suspicion of COVID-19, repeat swab tests are mandatory if previous tests were negative. The diagnosis and treatment plan of COVID-19 should not solely be based on RT-PCR, but also consider the patient's history, symptoms, laboratory result, and radiographic findings.
