A Case Report of Likely Nosocomial-Acquired COVID-19 in a Trauma Patient

Abstract

As the pandemic of coronavirus disease 2019 (COVID-19) continues to spread worldwide, there has been an increase in unique clinical presentations leading to delayed diagnoses and nosocomial transmissions. One of the patient populations most at risk includes patients in the critical care units. Early diagnosis and isolation are paramount to avoid nosocomial transmission amongst these closely hospitalized patients. While quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) is the current method for testing, we highlight the importance of utilizing chest computed tomography (CT) and laboratory findings for early diagnosis. We report a 48-year-old trauma patient who suddenly became hypoxemic, nine days postoperative from uncomplicated right lower extremity fracture repair. CT angiogram chest revealed bilateral extensive consolidations, hazy opacities, and pleural effusions. The patient continued to desaturate on noninvasive respiratory support and eventually required intubation. He was empirically treated with azithromycin and hydroxychloroquine due to high clinical suspicion of COVID-19, despite negative qRT-PCR results. The patient progressed clinically and was successfully extubated after 5 days. This unique presentation of acute hypoxemic respiratory failure warrants a discussion on the importance of clinical manifestations, CT findings, and laboratory findings in diagnosis of COVID-19, to prevent further nosocomial spread within a closed critical care unit.

J Curr Surg. 2020;10(3):37-40
doi: https://doi.org/10.14740/jcs409