Case ReportsAtypical Presentation of the Novel Coronavirus Disease 2019 and Lessons LearnedMithani, Farhan BS∗; Adrogue, Alexander†; Liu, Jonathan BS∗; Adrogue, Horacio E. MD‡Author Information From the ∗Texas A&M College of Medicine †Cornell University, Ithaca, NY ‡Department of Internal Medicine, Houston Methodist Hospital, Houston, TX. Correspondence to: Farhan Mithani, BS, Department of Internal Medicine, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, 77030. E-mail: email@example.com. The study was done as a part of routine care, and no external funding was received. The authors have no conflicts of interest to disclose. Written and verbal informed consent was given by the participant. Approval was obtained by the local medical authorities. Data sharing is not applicable to this article because no data sets were generated or analyzed during the current study. Infectious Diseases in Clinical Practice: September 2020 - Volume 28 - Issue 5 - p 295-298 doi: 10.1097/IPC.0000000000000874 Buy Metrics Abstract Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 and transmitted mainly via respiratory droplets. It is associated with several risk factors for nosocomial spread, including low sensitivity of reverse transcription-polymerase chain reaction (PT-PCR) testing and a nonspecific clinical presentation, mimicking other respiratory pathogens. Early isolation precautions and accurate testing are therefore crucial in preventing the spread of nosocomial infection. This case of an elderly, 80-year-old man, discusses one of the first reported cases of COVID-19 in Texas and addresses the topics of nosocomial spread due to inaccurate RT-PCR testing, underused isolation precautions, and atypical presentation in extremes of age. Recommendations include (1) early isolation precautions for any hospitalized patient who begins exhibiting respiratory symptoms with continued isolation precautions throughout the hospital course and (2) thorough clinical investigation of symptomatic patients with negative RT-PCR results using computed tomography chest imaging and basic laboratory findings. Early isolation precautions and accurate diagnosis of disease are crucial to prevent and contain the spread of COVID-19. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.