Unfortunately, this test is not 100% accurate and early reports from China suggest a false-negative result rate of up to 20%. Currently, the gold-standard for quick confirmation of COVID-19 is a real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). At present, April 2020, the United States has surpassed every country in the number of active cases, with over 900,000 cases and approximately 51,000 confirmed deaths since it was announced as a pandemic in late January. Although, this virus is notable for attacking the pulmonary system, causing acute respiratory distress syndrome (ARDS), it can also severely affect other systems in at-risk individuals including cardiovascular compromise, gastrointestinal distress, acute kidney injury, coagulopathies, cutaneous manifestations and ultimately death from multi-organ failure. The world is in the midst of a pandemic led by the recent outbreak of a novel coronavirus. The new pathogen is known as the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and by its official World Health Organization (WHO) disease name, COVID-19. We suggest that whenever a suspected COVID-19 patient is transferred to a specialized center, they should be isolated and re-checked before joining the new patient population for treatment of the unique condition. The delayed positive test results and complicated hospital course with our patient required us to scale back and notify every patient and staff member whom they came in contact with, across multiple institutions. Moreover, the internal COVID-19 test returned positive. A dermatopathological biopsy suggested a bullous drug reaction with an erythema multiform-like reaction pattern versus SJS/TEN. Given the lack of resolve of respiratory symptoms and concern for the burn patient population, the patient was placed in PUI protocol and an internal COVID-19 was ordered. The patient’s initial exam under standard COVID-19 airborne precautions revealed 5% total body surface area of loss of epidermis affecting bilateral thighs, bilateral arms, and face. After a second negative test result, the symptomatic patient was transferred to our burn center for expert wound management. Subsequently, dermatological symptoms developed and transfer to our burn center was initiated. Once negative results were obtained, the PUI protocol was abandoned despite ongoing symptoms. During observation, while waiting for results, she was placed under patient under investigation (PUI) protocol. Imaging and clinical presentation was consistent with COVID-19 and lab tests for the pathogen were ordered. The patient was admitted to her community hospital with febrile, acute respiratory distress. We present a confirmed COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital.Ī 58-year-old female with a history of morbid obesity, HTN, gout, CML managed with imatinib, and chronic kidney disease presented as a transfer from a community hospital to our burn center. Unfortunately, the reliability of negative test results is questionable and the high infectious burden of the virus calls for extended safety precautions, especially in symptomatic patients. The pathogen known as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is notable for attacking the pulmonary system causing acute respiratory distress, but it can also severely affect other systems in at-risk individuals including cardiovascular compromise, gastrointestinal distress, acute kidney injury, coagulopathies, cutaneous manifestations, and ultimately death from multi-organ failure. The recent outbreak of COVID-19 has put significant strain on the current health system and has exposed dangers previously overlooked.
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