{"doi":"10.1111/jgs.16680","title":"Nursing Home Physician with Normal Chest X‐Ray and Probable <scp>COVID</scp> ‐19 Based on <scp>18F‐Fluorodeoxyglucose PET</scp> / <scp>CT</scp> Imaging","abstract":"We report the clinical, laboratory, and imaging studies of a 75-year-old physician with a history of lymphoma who cared for coronavirus disease 2019 (COVID-19) patients in a nursing home and subsequently developed systemic and laboratory findings consistent with probable COVID-19 with minimal respiratory symptoms. Two reverse transcriptase–polymerase chain reaction (RT-PCR) tests for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid and his chest X-ray were negative. During hospitalization, a clinical diagnosis of COVID-19 was finally confirmed based on findings suspicious for COVID-19 on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging. The rationale for utilizing 18F-FDG PET/CT in suspected COVID-19 patients with a normal chest X-ray and selected comorbid neoplastic conditions with minimal or no respiratory symptoms and signs and the role of 18F-FDG PET/CT in elucidating the pathophysiology of COVID-19 are discussed. During 5 days before hospital admission, he self-quarantined with fever, headache, myalgias, anorexia, low back pain, and ageusia, with minimal cough and shortness of breath. A nasopharyngeal swab tested by RT-PCR was negative for SARS-CoV-2, other coronaviruses, and respiratory viruses, including influenza A and B. His oxygen saturation was greater than 95% on room air. Because of progressive anorexia, dehydration, and weakness, he was admitted to a New York City hospital with a temperature of 39°C, blood pressure of 143/91 mmHg, heart rate of 109 beats per minute, respiratory rate of 18 breaths per minute, and O2 saturation of 95% on room air. Table 1 provides laboratory findings. A second nasopharyngeal swab was negative for SARS-CoV-2, other coronaviruses, and a respiratory pathogen PCR panel. Because of persistent fevers and his history of lymphoma, an 18F-FDG PET/CT scan from skull base to thigh was performed. It revealed bilateral FDG-avid peripheral ground-glass opacities (GGOs), multilobe consolidations, and FDG-avid thoracic nodes suspicious for COVID-19–related infectious process (Figure 1). He was treated with intravenous hydration, low-molecular-weight heparin, antipyretics, and bed rest and discharged afebrile to home after a 5-day hospitalization to self-isolate and eventually return to work. Four hospitalized adult patients with respiratory symptoms highly suspected of having COVID-19 in Wuhan, China, had chest CT scan findings of GGOs and/or lung consolidations in more than two pulmonary lobes.1 Admission chest X-rays were not performed, as was the standard in suspected COVID-19 cases. Subsequent 18F-FDG PET/CT identified peripheral FDG-avid lesions consistent with a significant inflammatory burden similar to that seen in Middle East respiratory syndrome or the H1N1 pandemic influenza virus. Three of the four showed evidence of lymph node involvement suggestive of lymphadenitis. Despite the fact that RT-PCR for the detection of SARS-CoV-2 nucleic acid testing was not performed in three cases and was negative twice in one case (as in this case), all four of these cases had a clinical presentation, course, laboratory results, and imaging studies strongly suggestive of a diagnosis of COVID-19. Czemin et al reported an asymptomatic 53-year-old patient referred for restaging of a pancreatic neuroendocrine tumor with 18F-FDG PET/CT that showed hypermetabolic regions in two lobes, correlating with GGOs. COVID-19 infection was subsequently confirmed.2 Polverari et al reported a case of 18F-FDG/CT imaging in an asymptomatic 73-year-old male referred for evaluation of solitary lung nodule found on CT scan performed 4 years after resection for a non–small-cell lung cancer.3 Findings were consistent with GGOs and increased uptake in mediastinal and right paratracheal nodes. Subsequent testing with RT-PCR was positive for SARS-CoV-2. The authors thank Debra Berg, MD, for her critical review and Eric Wilck, MD, Jack Londo","journal":"Journal of the American Geriatrics Society","year":2020,"id":115684,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9503,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":543074,"name":"Anthony J. Lechich","orcid":null,"position":1,"is_corresponding":false},{"id":543073,"name":"Fredrick T Sherman","orcid":null,"position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-18T23:13:40.596604Z","pmid":"32535884","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}