Ece ŞAHİNOĞLU, Serap ARGUN BARIŞ, Sevtap DOĞAN, Aynur KARADENİZLİ, İlknur BAŞYİĞİT

COVID-19 PNÖMONİSİNİ TAKLİT EDEN SİSTEMİK LUPUS ERİTHEMATOSUS VAKASI

Koronavirüs hastalığı (COVID-19), dünya genelinde yüksek mortalite oranına sahip sağlık acil durumudur. Radyolojik bulguların COVID-19 ile uyumlu olmasının yanında, reverse transkripsiyon- polimeraz zincir reaksiyon (RT-PCR) testinin pozitifliği tanı için gereklidir. Bu çalışmada, 63 yaşında akciğer kanseri ve sistemik lupus eritematozus (SLE) öyküsü olan, öksürük ve nefes darlığı ile başvuran bir kadın hasta sunuldu. Toraks tomografisinde; COVID-19 pnömonisi ile uyumlu olan her iki akciğer alanlarında da yaygın buzlu cam dansiteleri saptandı. İki kez bakılan RT-PCR testi negatif olarak raporlandı. Hidroksiklorokin, azitromisin ve piperasilin-tazobaktam tedavisi sonrası anlamlı bir radyolojik düzelme görülemedi. SLE’nin akciğer tutulumu olabileceği düşünülerek metilprednizolon başlanan hastanın semptomlarında ve radyolojik bulgularında iyileşme izlendi. Altta yatan hastalıklar COVID-19 enfeksiyonunu taklit edebilir veya hastalığın belirti ve bulguları COVID-19 ile birlikte görülebilir.

Anahtar Kelimeler:

COVID-19, pnömoni, sistemik lupus eritematozus, ayırıcı tanı

A CASE WITH SYSTEMIC LUPUS ERITHEMATOSUS MIMICKING COVID-19 PNEUMONIA

Coronavirus-19 disease (COVID-19) is a worldwide health emergency which has a high mortality ratio. Diagnosis requires a positive reverse transcription-polymerase chain reaction (RT-PCR) test however there are radiological findings strongly suggest the diagnosis of COVID-19. Here we reported a 63-year-old woman presented with cough and dyspnea and medical history of lung cancer and systemic lupus erythematosus (SLE). Chest computed tomography demonstrated widespread ground glass opacities in both lung fields that have been reported to be compatible with COVID-19 pneumonia. RT-PCR test was negative for twice and radiological regression after hydroxychloroquine, azithromycin and piperacillin-tazobactam was not significant. Considering lung involvement of SLE methylprednisolone was initiated, symptoms and radiological findings improved. The underlying diseases may mimic the COVID-19 infection or the signs and symptoms of the disease may be seen together with COVID-19.

Keywords:

COVID-19, pneumonia, systemic lupus erythematosus, differential diagnosis,

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1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92(4):401-2. [CrossRef]
2. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020;5(4):536-44. [CrossRef]
3. Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology 2020;296(2):E55-E64. [CrossRef]
4. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020;30(6):3306-9. [CrossRef]
5. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol 2020;215(1):87-93. [CrossRef]
6. Keane MP, Lynch JP. III. Pleuropulmonary manifestations of systemic lupus erythematosus. Thorax 2000;55(02):159-66. [CrossRef]
7. Mathai SC, Danoff SK. Management of interstitial lung disease associated with connective tissue disease. BMJ 2016;352:h6819. [CrossRef]
8. Pego-Reigosa JM, Medeiros DA, Isenberg DA. Respiratory manifestations of systemic lupus erythematosus: old and new concepts. Best Pract Res Clin Rheumatol 2009;23(4):469-80. [CrossRef]
9. Lian F, Zhou J, Wang Y, Cui W, Chen D, Li H, et al. Clinical features and independent predictors of interstitial lung disease in systemic lupus erythematosus. Int J Clin Exp Med 2016;9(2):4233-42
10. Fidler L, Keen KJ, Touma Z, Mittoo S. Impact of pulmonary disease on patient-reported outcomes and patient performed functional testing in systemic lupus erythematosus. Lupus 2016.25:1004-11. [CrossRef]
11. Fenlon HM, Doran M, Sant SM, Breatnach E. Highresolution chest CT in systemic lupus erythematosus. AJR Am J Roentgenol 1996;166:301-7. [CrossRef]
12. Bertsias G, Ioannidis JP, Boletis J, Bombardieri S, Cervera R, Dostal C, et al. EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008;67:195-205. [CrossRef]
13. van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrøm K, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 2014;73:958-67. [CrossRef]
14. Chen LR, Chen ZX, Liu YC, Peng L, Zhang Y, Xu Q, et al. Pulmonary contusion mimicking COVID-19: A case report. World J Clin Cases. 2020;8(8):1554-60. [CrossRef]
15. Bekci T, Aslan S, Cakir IM. COVID- 19 pneumonia misdiagnosed as pulmonary contusion in a child. Br J Hosp Med. 2020;81(5):1. [CrossRef]