Abstract

Both chest computerised tomography (CT) and real time-polymerase chain reaction (RT-PCR) from swab samples are used in the diagnosis of 2019 novel coronavirus disease (COVID-19). RT-PCR is associated with increasingly high falsenegative rates, and sensitivity is dependent on how samples are taken. Chest CT is a more sensitive test, and the characteristic findings of ground-glass opacification are often found before positive RT-PCR results. Here, we present a 61-year-old female patient admitted with pyrexia and diarrhoea, with a recent travel history from Egypt. She was initially managed with intravenous antibiotics, but went into severe acute respiratory distress syndrome and was intubated. Serial chest X-ray (CXR) revealed patchy opacification correlated with severity of symptoms. Chest CT showed widespread extensive ground glass opacification resembling COVID-19 pneumonia. Two RT-PCR analyses from COVID-19 swabs were negative, as were investigations for other possible causes of ground glass opacification. She had supportive treatment for her symptoms, responded to this well, and was discharged home with no sequelae of disease. This case demonstrates the diagnostic pathway for COVID-19, differential diagnoses for radiological findings associated with COVID-19, and emphasises the advantage of CT as a diagnostic modality over RT-PCR in a subsection of cases.