Rationale: COVID-19 also known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV 2) is a virus known to cause pneumonia like clinical picture along with various respiratory and cardiovascular symptoms that exhibits thrombogenic activity and inflammatory events. Disease prognosis worsens with co-morbidities & other pre-existing conditions. currently, the treatment includes providing supplemental oxygen therapy, supportive and symptomatic care along with experimental Anti-Viral drugs and Corticosteroid therapy. Ultimately, mechanical ventilation in severe cases admitted to the intensive care unit. Patient complaints: A 44 year old male with H/O hyperlipidemia who presented with symptoms of worsening fever, mild icterus, breathlessness, diarrhoea and abdominal pain Diagnosis: Hepatitis A was confirmed positive on serological testing along with CXR showing patchy ground glass opacities in both lung bases and HRCT Chest showing multiple ill-defined sub plural opacities with ground glass attenuation showing crazy paving pattern. These findings were consistent with COVID-19. However, RT-PCR revealed a negative result prior to HRCT Chest. Interventions: Patient was unwilling to undergo hospital admission & second RT-PCR. Thus, after high risk consent from patient and his relatives, he was started on supplemental oxygen therapy, Azithromycin, Favipiravir, Dexamethasone, LMWH, along with other supportive treatment including zinc, glutathione. Vitamin C, Vitamin D3 and a Multivitamin. The patient completed the full course of treatment advised in home isolation without deterioration. Outcome: The patient’s health improved with near complete resolution of COVID-19 changes on HRCT, remission of all symptoms and return of all haematological parameters to baseline. Lessons: The simultaneous presence of two viral infection like Hepatitis-A & COVID-19 can lead to rapid deterioration of patient’s condition and progression of their symptoms. Also, the presence of two viral infections can lead to further complexity due to overlapping symptoms of the two infections causing a diagnostic challenge and thus delaying diagnosis. Anti-Viral Therapy (Favipiravir) approved for moderately symptomatic COVID patients are known to elevate liver enzymes, which is also seen as a result of Hepatitis-A thus making therapeutic decisions sceptic. Therefore, regular monitoring of Liver enzymes is key to monitor disease prognosis and prevent further complications which is not routinely done in standalone COVID-19 cases. Early diagnosis and intervention on display of COVID-19 symptoms can prevent deterioration and need for mechanical ventilation and also prevent extensive lung fibrosis post COVID-19. RT-PCR shows significant false negative results and should not be considered as the only diagnostic modality for COVID-19. Diagnosis should comprise of RT-PCR along with HRCT chest and must be co-related clinically to establish a strong diagnosis of COVID-19 with the use of Chest X-Ray as an inexpensive radiological Screening test.
