Significance of Differential Diagnosis for Febrile and Fatigued Patients in an Endemic Area During The COVID-19 Pandemic: Consideration of COVID-19, Brucellosis, and Crimean-Congo Hemorrhagic Fever

Brucellosis and Crimean-Congo Hemorrhagic Fever are diseases that can present with similar clinical and laboratory findings to those of COVID-19. This can delay diagnosis and increase the risk of nosocomial transmission in the case of Crimean-Congo Hemorrhagic Fever. Although misdiagnosis of Brucellosis and Crimean-Congo Hemorrhagic Fever, and even a case of coinfection have been reported in the literature, no case report mentioning Crimean-Congo Hemorrhagic Fever and Brucellosis coinfection hospitalized with the pre-diagnosis of COVID-19 was found. A 35-year-old female patient presented to the emergency service with complaints of fever and fatigue. The patient was evaluated in the emergency triage and was taken to the area where COVID-19 pre-diagnosed patients were being examined. A thorax computed tomography without intravenous contrast usage was reported as normal, and the patient was discharged after being informed about COVID-19 transmission routes. The patient re-applied to the emergency service with complaints of fever, fatigue, headache, and myalgia four days later. The laboratory findings showed a white-cell count of 1600/mm(3), haemoglobin of 12,8 g/liter, platelet of 146000/mm(3), urea of 21,5 mg/dl, creatinine of 0,81 mg/dl, alanine aminotransferase of 134 U/liter, aspartate aminotransferase of 303 U/liter, lactate dehydrogenase of 714 U/liter, creatine kinase of 1796 U/liter, C-reactive protein of 3 mg/liter, D-dimer of 2000 mu g/liter, and a thorax computed tomography showed minimal ground-glass opacity. The patient was hospitalized with a preliminary diagnosis of COVID-19 by the chest diseases clinic. This case highlights the importance of considering other diseases with similar clinical and laboratory findings in endemic regions of Brucellosis and Crimean-Congo Hemorrhagic