Case presentation
A 35-year-old Iranian man presented with a two-day history of sore
throat and mild shortness of breath. There was no history of fever or
chest pain. The patient did not have any history of suspicious contact
with COVID 19 patients. He did not have any chronic medical illnesses,
and was a non-smoker. On physical examination, he had a temperature of
37.5°C, blood pressure of 130/82 mmHg, and respiratory rate (RR) of 26
breaths/min. His oxygen saturation on room air was to 82% and required
10 liters of oxygen via a face mask to maintain oxygen saturation above
95%. The patient had laryngeal erythema and on respiratory examination
bilateral coarse crackles was heard. Complete blood count revealed
lymphopenia but others were normal (WBC, hemoglobin, and platelet
counts). Alanine aminotransferase (ALT), aspartate aminotransferase
(AST), and lactate dehydrogenase were elevate C-reactive protein (CRP)
and interleukin-6 (IL-6) were elevated , but d-dimer level was normal
(Table 1). A chest X-ray and CT–scan showed bilateral middle and lower
and upper zone infiltrates (Figure A,B,C,D). A RT-PCR nasopharyngeal
swab was positive for SARS-CoV-2.
TABLE 1. Laboratory parameters of the patient at admission