Haemoptysis as the first presentation of COVID-19: a case report
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CASE REPORT
Open Access
Haemoptysis as the first presentation of COVID-19: a case report Elise Peys1,2* , Dieter Stevens1,2, Yannick Vande Weygaerde2, Thomas Malfait2, Laurens Hermie3, Philippe Rogiers4, Pieter Depuydt1,5 and Eva Van Braeckel1,2
Abstract Background: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that profoundly challenges healthcare systems all over the world. Fever, cough and fatigue are the most commonly reported clinical symptoms. Case presentation: A 58-year-old man presented at the emergency department with acute onset haemoptysis. On the fifth day after admission, he developed massive haemoptysis. Computed tomography (CT) angiography of the chest revealed alveolar haemorrhage, more prominent in the left lung. Flexible bronchoscopy confirmed bleeding from the left upper lobe, confirmed by a bronchial arteriography, which was successfully embolized. Nasopharyngeal swabs (NPS) tested for SARS-CoV-2 using real-time polymerase chain reaction (RT-PCR) repeatedly returned negative. Surprisingly, SARS-CoV-2 was eventually detected in bronchoalveolar lavage (BAL) fluid. Conclusions: Life-threatening haemoptysis is an unusual presentation of COVID-19, reflecting alveolar bleeding as a rare but possible complication. This case emphasises the added value of bronchoscopy with BAL in the diagnostic work-up in case of high clinical suspicion and negative serial NPS in patients presenting with severe symptoms. Keywords: COVID-19, Haemoptysis, Alveolar bleeding, Bronchoalveolar lavage, Case report
Background Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing pandemic that profoundly challenges healthcare systems all over the world. Scientific evidence on this new virus is growing and the clinical characteristics are increasingly understood. Among COVID-19 patients, fever, cough and fatigue are the most commonly reported clinical symptoms. The main reason for hospitalisation is the onset of acute hypoxemic respiratory failure [1]. Haemoptysis is rarely reported as a symptom of COVID19. Only very few cases have been described in literature [1, * Correspondence: [email protected] 1 Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium 2 Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium Full list of author information is available at the end of the article
2]. Here, we report an unusual case of a man who presented with life-threatening haemoptysis as the first and unique symptom of COVID-19.
Case presentation In the spring of 2020, a 58-year-old man with moderate chronic obstructive pulmonary disease (COPD) presented at the emergency department of the referring regional hospital with moderate haemoptysis of acute onset. He reported no fever, chills, chest pain or worsening dyspnoea. A recent extensive diagnostic work-up for unintentional weight loss was negative
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