Arthralgia as an initial presentation of COVID-19: observation

Abstract

Dear Editor, Arthralgia is an important clinical complaint seen in many virus infections. For a new emerging disease from China, COVID-19 [1], the data on the rheumatic manifestation are limited. In a clinical epidemiology report published in Lancet, no data on joint complaint of the patients are mentioned [2, 3]. Here, the authors would like to share observation from Thailand, the second country where the disease exists [4]. In Thailand, at present (28 February 2020), there are 40 patients. Of these 40 patients, at least one patient (2.5%) presented with joint pain complaint. The case is a female patient who initially presented with high fever and low platelet count was observed. The patient further developed respiratory difficulty and pneumonia was detected. The diagnosis of the test is by molecular diagnosis for COVID-19. This case was primarily miss diagnosed as dengue in a local hospital and the patient was referred to tertiary care hospital after COVID-19 was confirmed. The patient was managed by the standard respiratory supportive care and full recovered. This report can imply the importance of rheumatic complaint in COVID-19. In the setting where viral arthropod borne disease is common, the COVID-19 with arthralgia might be easily missed.