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).