Acute Exacerbation of Rheumatoid Arthritis Misdiagnosed as COVID-19: A Case Report.
Acute Exacerbation of Rheumatoid Arthritis Misdiagnosed as COVID-19: A Case Report.
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DOI：
10.3389/fmed.2022.844609
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发表时间：
2022
影响因子：
3.9
通讯作者：
Karaman I
中科院分区：
文献类型：
--
作者：
Torun S;Karaman I
类风湿性关节炎（RA）是一种全身性炎症性结缔组织疾病，影响全球1-2%的人口。高达30-40%的RA患者可出现肺间质性疾病（ILD）、气道疾病、胸膜和血管疾病等肺部表现，这被认为是RA患者死亡的第二大常见原因。有文献报道了合并或不合并ILD的RA患者同时发生COVID-19，以及RA相关ILD与COVID-19肺部表现的异同。然而，在大流行期间，没有报道过因RA加重导致ILD新诊断的患者临床表现分化的病例。在这里，我们报告了一位RA患者，由于非特异性呼吸道症状和高分辨率CT观察到的磨玻璃混浊，他被误诊为COVID-19两次。误诊导致ILD的诊断延迟和肺部症状延长。临床医生必须在整个诊断过程中严格审查患者，考虑到COVID-19以外的其他疾病，特别是在没有确认结果的情况下。ILD或ILD恶化与COVID-19之间的联系仍有待确定。虽然该领域的研究仍在继续，但重要的是要考虑到COVID-19在ILD恶化病例中的重要性，反之亦然。区分COVID-19和ILD的肺部影像学表现是一个主要问题。尽管COVID-19的主要表现是呼吸道症状，但临床医生应警惕具有相同症状的其他常见疾病。临床医生应仔细区分COVID-19和风湿病发作的鉴别诊断。
Rheumatoid arthritis (RA) is a systemic inflammatory connective tissue disease that affects 1–2% of the population worldwide. Pulmonary manifestations including interstitial lung disease (ILD), airway disease, pleural and vascular disease can be seen in up to 30–40% of patients with RA, which are recognized as the second most frequent cause of death in RA patients. The simultaneous occurrence of COVID-19 in RA patients with or without ILD, and the similarities and differences between RA-related ILD and COVID-19 lung findings have been reported in the literature. However, there was no reported case on differentiation of clinical findings of a patient with RA exacerbation causing a new diagnosis of ILD during the pandemic conditions. Here, we presented a patient with RA who was misdiagnosed as COVID-19 twice due to non-specific respiratory symptoms and ground-glass opacities observed in high-resolution CT. The misdiagnosis led to a delayed diagnosis of ILD and prolonged pulmonary symptoms. Clinicians must critically review patients throughout the diagnostic workup by thinking other diseases besides COVID-19, particularly in the absence of a confirmatory result. The link between ILD or ILD exacerbation and COVID-19 remains to be determined. While research continues in the field, it is important to consider the importance of COVID-19 in cases of ILD exacerbation, and vice versa. Distinguishing lung imaging findings of COVID-19 from ILD is a major concern. Even though the primary manifestation of COVID-19 consists of respiratory symptoms, clinicians should be vigilant for other common conditions having the same symptoms. Clinicians should carefully distinguish a differential diagnosis between COVID-19 and a flare of rheumatic disease.
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