Metastatic pulmonary dissemination as differential diagnosis of COVID-19 disease

• Published in: BMJ case reports 2020-10, Vol.13 (10), p.e237453
• Main Authors: Perdigón Martinelli, Cristel, Morell, Carlos, González, Carolina, Nova-Lozano, Cristina
• Format: Article
• Language: English
• Subjects: Adolescent; Antibodies; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Bone marrow; Bone Marrow Examination - methods; Case reports; Clinical Laboratory Techniques - methods; Coronavirus Infections - blood; Coronavirus Infections - diagnosis; Coronavirus Infections - physiopathology; Coronaviruses; COVID-19; COVID-19 Testing; Diagnosis, Differential; Disease; Ewings sarcoma; Fever; Hospitals; Humans; Immunoassay; infectious diseases; Laboratories; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - physiopathology; Lung Neoplasms - secondary; Lungs; Male; Medical diagnosis; Metastasis; Monoclonal antibodies; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - pathology; paediatric intensive care; paediatric oncology; Pandemics; Patients; Pediatrics; Pneumonia; Pneumonia, Viral - blood; Pneumonia, Viral - diagnosis; Pneumonia, Viral - etiology; Pneumonia, Viral - physiopathology; Respiratory failure; Sarcoma; Sarcoma, Ewing - diagnosis; Sarcoma, Ewing - physiopathology; Serology; Severe acute respiratory syndrome coronavirus 2; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Unusual Presentation of More Common Disease/Injury; Viruses
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-237453

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks’ duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing’s sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.