PDF(Pubmed)
Abstract：
The coronavirus disease 2019 (COVID-19) pandemic favors cognitive biases such as anchoring and availability biases. The first refers to overvaluing some of the initial information and establishing a diagnosis too early, with resistance to future adjustments. The latter happens when diagnoses more frequently considered are regarded as more common in reality. This case, in which the correct diagnosis was delayed due to these biases, highlights the need to remain aware of them as a means toward timely diagnosis and therapeutic success of pneumonia cases. An 84-year-old woman presented with a mild non-productive cough for two months and fever. She had a history of breast carcinoma treated with radiotherapy in the previous year. Computerized tomography (CT) showed extensive bilateral consolidation foci with ground-glass-opacification areas and bilateral pleural effusion, CO-RADS 3. COVID-19 with bacterial superinfection was suspected and levofloxacin was initiated. Nasopharyngeal swab polymerase chain reaction (PCR) was carried out three times, always negative for SARS-CoV-2. As the patient remained with fever and cough, the antibiotic was escalated to piperacillin/tazobactam and then to meropenem/vancomycin. She underwent bronchofibroscopy and alveolar lavage, with negative SARS-CoV-2 PCR. The re-evaluation CT scan maintained bilateral consolidations, with an aerial bronchogram. The biopsy of pulmonary consolidation allowed the diagnosis of radiation-induced organizing pneumonia. Prednisolone was initiated and achieved clinical remission and radiological improvement. This case highlights the need to remain aware of cognitive biases both when COVID-19 is suspected or ruled out and to consider other diagnoses when there is a lack of therapeutic response.
摘要：
2019年冠状病毒病（COVID-19）大流行有利于认知偏见，如锚定和可用性偏见。第一个是指高估一些初始信息，过早建立诊断，抵制未来的调整。后者发生在更频繁考虑的诊断被认为在现实中更常见时。这个案子,由于这些偏见，正确的诊断被推迟了，强调需要保持意识到他们作为一种手段，及时诊断和治疗成功的肺炎病例。一名84岁的妇女出现了两个月的轻度非生产性咳嗽和发烧。她在前一年有接受放射治疗的乳腺癌病史。计算机断层扫描（CT）显示广泛的双侧巩固灶，伴有毛玻璃混浊区和双侧胸腔积液。CO-RADS3.怀疑有细菌重复感染的COVID-19，并开始使用左氧氟沙星。鼻咽拭子聚合酶链反应(PCR)进行3次,SARS-CoV-2总是阴性。由于病人仍然发烧和咳嗽，将抗生素升级为哌拉西林/他唑巴坦,然后升级为美罗培南/万古霉素.她接受了纤维支气管镜检查和肺泡灌洗,SARS-CoV-2PCR阴性。重新评估CT扫描保持了双侧合并，有一个空中支气管图。肺实变的活检可以诊断为放射性机化性肺炎。开始使用泼尼松龙，并获得临床缓解和放射学改善。这一病例强调，当怀疑或排除COVID-19时，需要保持认知偏见，当缺乏治疗反应时，需要考虑其他诊断。
