Don’t overlook flank pain in apparently asymptomatic COVID-19 cases: A case report and literature review

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Figure 1
- Baseline axial computed tomography image through the lower chest showing: a) patchy ground glass and reticular opacities in the peripheral lung bases, b) multiple focal non-enhancing hypodensities, which are consistent with infarcts, are visible at the mid and lower poles of the left kidney on the axial and c) coronal images, and d) patent renal arteries on both sides are demonstrated by maximum intensity projection images.
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Figure 2
- A follow up computed tomography showing focal scaring at the lower pole of the left kidney. a) Sagittal and b) coronal images.
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Figure 3
- Case timeline. COVID-19: coronavirus disease-2019, CT: computed tomography

Table 1

- Laboratory investigations

Laboratory findings	Value	Reference range
CRP	19.60 mg/L	≤1.20 mg/L
Ferritin	471.7 μg/L	21.8-274.6 μg/L
LDH	1210 U/L	125-220 U/L
Creatinine	72 μmol/L	64-110 μmol/L
eGFR	117 mL/min/1.73 m²	≥60 mL/min/1.73 m²
PTT	27.6 s	21.8-29.4 s
PT	16.5 s	7.6-10.4 s
PT control	10.0 s	11.0-14.0 s
PT-Sec	16.0 s	11.6-14.6 s
INR	1.8	0.8-1.2
PT-INR	1.3	*
D-dimer	0.80 mg/L	0.00-0.50 mg/L
WBCs	12.20 x 10⁹/L	4-11 x 10⁹/L
Neutrophils	8.87 x 10⁹/L	2-7.5 x 10⁹/L
Monocytes	1.35 x 10⁹/L	0.1-1.1 x 10⁹/L
RBCs	6.30 x 10¹²/L	4.5-6.1 x 10¹²/L
Hgb	169 g/L	135-180 g/L
Platelets	351 x 10³/mcL	150-400 x 10³/mcL
HCT	0.544 L/L	0.42-0.54 L/L
Free T4	8.7 pmol/L	9.0-19.0 pmol/L
TSH	6.78 mIU/L	0.35-4.94 mIU/L
Serum BGP1 IgM	4.51 SMU	<20 SMU (-) and >20 SMU (+)
Serum BGP1 IgG	0.60 SGU	<20 SGU (-) and >20 SGU (+)
Serum BGP1 IgA	2.11 SAU	<20 SAU (-) and >20 SAU (+)
ACA total Ab IgA	2.86 APL unit	<12 APL unit (-), >80 APL unit strong (+)
ACA total Ab IgM	18.55 MPL unit	<12.5 MPL unit (-), >80 MPL unit strong (+)
ACA total Ab IgG	4.76 GPL unit	<15 GPL unit (-), >80 GPL unit strong (+)
LA1	41.7 s	30-43 s
Lupus group anticoag	Negative
Factor V gene mutation (Leiden mutation)	Wild type (“Leiden” mutation not detectable)
Prothrombin (factor II) mutation	Wild type (no mutation present)
Molecular genetic analysis of mutation c.1849G>T p.(V617F) in exon 14 of the JAK2 gene	Not detected

*No treatment: >3.0, for patient on coumadin/warfarin therapy: >5.0, for thromboembolic states: 2.0-3.0, for artificial heart valves and recurrent embolism: 2.5-3.5, CRP: C-reactive protein, LDH: lactate dehydrogenase, eGFR: estimated glomerular filtration rate, PTT: partial thromboplastin time, PT: prothrombin time, INR: international normalization ratio, WBCs: white blood cells, RBCs: red blood cells, Hgb: hemoglobin, HCT: hematocrit, T4: thyroxine 4, TSH: thyroid stimulating hormone, BGP1: beta 2-glycoprotein 1, ACA total Ab: anti-cardiolipin antibody, LA1: Lupus group, s: second, SAU: surgical assessment unit, Ig: immunoglobulin, APL: IgA phospholipia units