LAUSR

In March 2020, during the 2019 novel coronavirus disease (COVID-19) pandemic, caused by the newly emerged virus SARS-CoV-2, two patients with homozygous sickle cell disease (SCD) were admitted to our hospital with a painful vaso-occlusive crisis (VOC) triggered by COVID-19. Both patients had no flu-like complaints characteristic of COVID-19 during or preceding the VOC episode. Patient 1, a 24-year-old man with a previous medical history of minor pain episodes without indication for hospitalization, presented with severe right thoracic pain for 3 days. At presentation he had a temperature of 37.6°C; pulse of 76/minute, blood pressure of 106/65 mmHg; respiration rate of 18/min and a peripheral oxygen saturation (SpO2) of 97%. A non-contrast chest CT showed doublesided infiltrates without ground-glass opacities or crazy paving and was not characteristic of COVID-19 (Image 1A). Throat and nose swabs were negative for SARS-CoV-2. A diagnosis of VOC complicated by acute chest syndrome (ACS) was made. Treatment with oxygen, intravenous morphine with patientcontrolled analgesia (PCA), fluid replacement therapy and amoxicillin/ clavulanic acid was initiated. After 1 day, the level of pain had decreased significantly (numeric rating scale decreasing from nine to two) and the patient remained respiratory stable throughout his hospital stay. He was discharged with amoxicillin/clavulanic acid continued at home. However, the next day he returned to the emergency room with increased pain, dyspnea, respiration rate of 20/minutes, SpO2 of 93% and a temperature of 38.9°C. Chest CT imaging showed progression of the double-sided infiltrates in the lower lobes of the lungs IMAGE 1 A, Chest CT imaging of patient 1 at first presentation to the emergency room (ER) showing infiltrates at basal fields. B, CT imaging at second ER presentation of patient 1, showing an increase in double-sided infiltrates Received: 31 March 2020 Revised: 2 April 2020 Accepted: 3 April 2020