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