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.