covid-19

The patient had been well until 2 months before this evaluation, when intermittent nonproductive cough and wheezing developed. She had no fever, chills, or shortness of breath. Two days before this evaluation, the cough worsened in frequency and severity and new shortness of breath developed. The patient was evaluated by her primary care physician by telephone call. Humidification, fluticasone nasal spray, and fexofenadine were recommended, as was a follow-up telephone call in 2 weeks.

However, the next day, the patient sought evaluation at the emergency department of this hospital because of worsening shortness of breath with ambulation. A review of systems was notable for rhinorrhea, myalgias, and dizziness. She had no fever, chills, sore throat, chest pain, nausea, vomiting, abdominal pain, diarrhea, leg swelling, or weight loss.

The patient had a history of eczema and gestational diabetes. Medications included azelastine nasal spray, fluocinonide cream, folate, and ferrous sulfate; she had not yet begun to use the fluticasone nasal spray and fexofenadine that had been newly recommended by her primary care physician. There were no known drug allergies. The patient was originally from the equatorial region of South America and had moved to the United States 20 years earlier; she had not traveled outside the United States in many years. She lived in an apartment in an urban area of New England with her husband and five children. She did not drink alcohol, smoke tobacco, or use illicit drugs. Her mother had had diabetes and melanoma.