Atypical Presentation of the Novel Coronavirus Disease 2019 and Lessons Learned

Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 and transmitted mainly via respiratory droplets. It is associated with several risk factors for nosocomial spread, including low sensitivity of reverse transcription-polymerase chain reaction (PT-PCR) testing and a nonspecific clinical presentation, mimicking other respiratory pathogens. Early isolation precautions and accurate testing are therefore crucial in preventing the spread of nosocomial infection. This case of an elderly, 80-year-old man, discusses one of the first reported cases of COVID-19 in Texas and addresses the topics of nosocomial spread due to inaccurate RT-PCR testing, underused isolation precautions, and atypical presentation in extremes of age. Recommendations include (1) early isolation precautions for any hospitalized patient who begins exhibiting respiratory symptoms with continued isolation precautions throughout the hospital course and (2) thorough clinical investigation of symptomatic patients with negative RT-PCR results using computed tomography chest imaging and basic laboratory findings. Early isolation precautions and accurate diagnosis of disease are crucial to prevent and contain the spread of COVID-19.