Case Presentation
Patient is a 31-year-old Caucasian resident physician with a laboratory-confirmed diagnosis of COVID-19 in July 25th 2020. The patient initially presented with a 3-day history of fever (oral temperature of 99.8 °F), malaise, cough, shortness of breath, anosmia, and a dropped O2 saturation to 88% on room air. A computerized tomography (CT) of the chest showed bilateral ground glass opacity of the lungs (Figure 1). He was admitted to the intensive care unit (ICU) and received supportive treatment with supplemental oxygen 3-4 liter/minute, hydroxy chloroquine tablet 200 mg twice a day, and 6 mg intravenous dexamethasone daily. He recovered uneventfully in one week with an O2 saturation of 94%, and resumed his duty without any restrictions. Although complaining of chronic fatigue for a few weeks, a follow-up nasal swab polymerase chain reaction (PCR) testing for SARS-CoV-2 got negative two weeks after the discharge from the hospital.
In October 12th, 2020 (79 days after the initial encounter), the patient developed malaise followed by painful submandibular lymphadenopathy and gingival aphtous ulcers (Figure 2). Two days later, he developed fever (oral temperature: 99.8 °F) and myalgia. A PCR test of the nasopharyngeal swab was positive for COVID-19 and the patient quarantined himself taking naproxen tablet 250 mg every 12 hours for 4 days. As he did not have any shortness of breath, he did not seek a medical care and hence no chest imaging was obtained. Although his symptoms improved over the next 3 days, he developed skin desquamation of the palms and fingers (Figure 3). The skin changes improved swiftly over the course of a week as did his other symptoms. The patient did not require any other medication.