Case presentation
A 64 year old male with hypothyroidism, on a daily dose of levothyroxine
100 mcg, presented to our emergency department with the complaint of
difficulty in breathing of gradual onset and progressive in nature for
the past 5 days associated with chest tightness. He denied the presence
of any other symptoms. He had a history of coming into contact with
COVID-19 patients and a history of domestic travel within the country in
the last two weeks.
The only abnormal findings on physical examination were oxygen
saturations of 79% on room air and tachypnoea of 26 breaths/min. Blood
pressure and heart rate on arrival were 124/71 mmHg and 101 beats per
minute respectively. Chest auscultation revealed bilateral basal
crackles anteriorly and the entirety of the posterior, superior and
inferior aspects had crackles. It was noted that the patient experienced
fatiguability on moderate exertion however had no difficulty in
completing sentences.
Chest X-ray (PA and lateral views) was done and revealed bilateral
peripheral and central alveolar infiltrates suggestive of atypical
pneumonia (Figure 1). Nasal swab PCR test for COVID-19 was positive. A
series of blood investigations were performed on Day 1, 3, 5 and 7 of
hospital stay (Table 1).