Talalaev MA, Ghazvini K, Manella S, Tse A, Lazovic G and Arenstein J
Introduction: A chest CT plays a pivotal role in the early detection and diagnosis of COVID-19 pulmonary disease. Concurrent infections of and Mycoplasma pneumonia and may present additional challenges with respect to diagnosis, treatment, and recovery of patients with superimposed pulmonary processes.
Patient Concerns: A 39-year-old male presented to the Emergency Room with fever and malaise for three days. Patient denied cough or dyspnea.
Diagnosis: Chest x-ray (CXR) showed a cavitary lesion in the left mid-lung consistent with a possible lung abscess. Chest Computed Tomography (CT) revealed bilateral multifocal mixed ground-glass/solid airspace opacities, but no pleural effusion, pneumothorax, or pleural thickening. Microbiologic and serologic evaluation demonstrated positive Mycoplasma IgM and positive COVID-19 test. Interventions: Patient was treated with Azithromycin IV and standard steroid course, and showed rapid improvement.
Outcomes: Repeated CXR demonstrated mild interval improvement of bilateral ground-glass opacities and interval resolution of left lung opacity.
Conclusion: Amid the COVID-19 pandemic, physicians must be on the lookout for other infections that can masquerade or co-infect, such as Mycoplasma pneumonia. Since results of the COVID-19 nasal swab may take days, radiography is crucial in distinguishing between the two infections. A 39 year old male presented to the Emergency Room with fever and malaise for three days. Physical exam was unremarkable except for a fever of 101.2 F. A chest x-ray (CXR) showed a cavitary lesion in the left mid-lung consistent with a possible lung abscess, while a Chest Computed Tomography (CT) revealed bilateral multifocal mixed ground-glass/solid airspace opacities, but no pleural effusion, pneumothorax, or pleural thickening. Microbiologic and serologic evaluation demonstrated positive Mycoplasma IgM and a COVID-19 test returned positive result. Patient was diagnosed with COVID-19 Pneumonia and Mycoplasma pneumonia and treated with Azithromycin IV (intravenous) and standard steroid course and subsequently discharged after patient improved. Patients with suspected/presumed COVID-19 multifocal pneumonia should be evaluated for secondary bacterial causes of pneumonia. There should be low threshold for performing CT chest in patients with presumed COVID-19 pneumonia, as imaging may show changes more consistent with superimposed bacterial process. We recommend that initial evaluation of presumed COVID-19 patients should include respiratory culture, Mycoplasma Ag, Legionella urinary Ag, and antibiotic coverage should be adjusted accordingly.
