COVID-19: to be or not to be; that is the diagnostic question. Issue 1137 (10th June 2020)

• Record Type: Journal Article
• Authors: Coleman, Jamie J; Manavi, Kaveh; Marson, Ella J; Botkai, Adam H; Sapey, Elizabeth
• Is Part Of: Postgraduate medical journal. Volume 96:Issue 1137(2020)
• Page Start: 392
• Page End: 398
• Publication Date: 2020-06-10
• Subjects: infectious diseases -- respiratory infections; Medicine -- Periodicals; 610
• DOI: 10.1136/postgradmedj-2020-137979
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract: Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions. This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses. While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.