COVID-19 pneumonia presenting as a single pulmonary nodule in a kidney transplant recipient: A case report and literature review

In December 2019, the outbreak of Severe Acute Respiratory Syndrome coronavirus 2 (SARS CoV2) which is the cause of coronavirus disease 19 (COVID-19) has begun in Wuhan, China's Hubei province [1]. The clinical presentations of the novel infection in general population are considered to be fever, dry cough, fatigue, nausea [2]. Patients with underlying diseases and co-morbidities may end up to acute respiratory distress syndrome, and eventually death [3]. The diagnosis of the disease is based on clinical features of the disease, laboratory abnormalities including elevated C-reactive protein, lymphopenia and elevated lactate dehydrogenase which would be confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) test [4]. In this regard, the role of medical imaging, especially chest x-ray and chest computed tomography (CT) scan, is crystal clear [5]. The main chest CT findings in patients with COVID-19 are bilateral ground-glass opacities, consolidations, and septal thickenings [6]. Previous studies have also mentioned that COVID-19 patients could have the CT characteristic features of architectural distortion in a peripheral distribution, ground glass pulmonary nodules and discrete nodules, and multifocal organizing pneumonia [5]. Immunocompromised patients commonly present atypical presentations of viral diseases [7]. For instances, herpes simplex virus and cytomegalovirus had led to esophageal symptoms in patients with human immunodeficiency virus (infection) [8]. Furthermore, previous investigations have reported that viral infection could result pulmonary nodules in immunocompromised patients [9]. Considering the SARS CoV-2, a prior investigation has noticed that the infection in immunocompromised patients may cause gastrointestinal symptoms including nausea, vomiting, and diarrhea [10]. Conversely to the fact that these patients are more susceptible to the infections, there is limited information regarding the features of COVID-19 in immunocompromised population (Figs. 1 and ​and22). Open in a separate window Fig. 1 A: plain PA chest X-ray reveals a small pulmonary nodule in right lower lobe. B: spiral chest CT scan axial section at level of pulmonary veins demonstrates a 29×27 mm solid nodule with faint peripheral halo of ground glass density.