Case history

Case history

A 50-year-old man presents with a 4-day history of fever, progressive dyspnea, and dry cough, and a 2-day history of nausea and diarrhea. His history is significant for smoking and type 2 diabetes mellitus. He reports arriving in the US from the Arabian Peninsula, where he lives, 10 days ago for the purpose of a vacation. He reports recent contact with his brother, a camel herder, who is currently in the hospital being investigated for an acute viral respiratory infection. Examination reveals a temperature of 100.8°F, a respiratory rate of 22 breaths per minute, and oxygen saturation of 88%. Chest examination is normal. Laboratory workup reveals leukopenia, lymphopenia, thrombocytopenia, elevated alanine aminotransferase, and elevated creatinine.

Other presentations

The majority of patients present with fever and respiratory symptoms (e.g., cough, dyspnea); however, some patients may present with gastrointestinal symptoms only (e.g., nausea, vomiting, diarrhea, abdominal pain). Other symptoms include myalgia, arthralgia, headache, chills/rigors, sore throat, and rhinorrhea.[4][5][6]​​[7]​​[8]​​[9]​​[10] Fever may be absent in older patients, immunocompromised patients, pregnant women, and patients with end-stage renal disease, diabetes mellitus, or hemochromatosis.[5] Some patients, particularly young, healthy patients, may be asymptomatic or present with mild respiratory symptoms and a normal chest x-ray.[11]​ However, others, particularly older patients or those with comorbidities, may present with severe, rapidly progressive pneumonia, acute respiratory distress syndrome, septic shock, or multiorgan failure resulting in death. A patient who presented with acute renal failure caused a superspreader event in Riyadh (Saudi Arabia) in 2017, highlighting the difficulties in diagnosing pneumonia in patients with renal and cardiac failure.[12] Infection in children is rare.​[13][14]​​

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