Case 40-2020: A 24-Year-Old Man with Headache and Covid-19

Abstract

T h e ne w e ngl a nd jou r na l o f m e dicine Pr esentation of C a se Dr. Stephanie M. Shatzman (Medicine): A 24-year-old man was admitted to this hospital in the spring of 2020 because of headache and coronavirus disease 2019 (Covid-19), the illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient had been in his usual state of health until 3 weeks before this admission , when fatigue, generalized weakness, and headache developed. He also had myalgias, nausea, and vomiting but no fever, cough, or diarrhea. Ibuprofen and aspirin did not alleviate the symptoms. Two weeks later, headache and weakness persisted and new shortness of breath, pleuritic pain, and anorexia developed. Five days before this admission, the patient sought evaluation at a local urgent care clinic. The temperature was 36.8°C, and the oxygen saturation 98% while he was breathing ambient air. Physical examination was normal. Laboratory test results are shown in Table 1. A nasopharyngeal swab was obtained to test for SARS-CoV-2 RNA. Intramuscular ketorolac was administered , and the patient was discharged home with recommendations to quarantine. The next day, SARS-CoV-2 RNA was detected in the nasopharyngeal swab, and the patient had a telemedicine visit through the urgent care clinic. He reported headache, nausea, anorexia, and weakness. Four days later, the headache worsened , and he had presyncope; he sought evaluation at the emergency department of this hospital. On arrival at the emergency department, multiple episodes of vomiting occurred. The patient described headache and pain localized behind the eyes, as well as persistent shortness of breath, pleuritic pain, myalgias, nausea, vomiting, and anorexia. There was no fever, cough, abdominal pain, or diarrhea. The patient had