A Case of Severe COVID-19 Pneumonia Diagnosed in Bronchoscopy With Negative Repeated Nasopharyngeal Swabs

Abstract

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic that had emerged in China since December 2019. The disease affects all age groups, with clinical manifestations in the spectrum from asymptomatic to rapidly lethal multi-organ failure, mainly involving the respiratory system. Diagnosis is confirmed mainly by a positive real-time polymerase chain reaction (PCR) nasopharyngeal swab. It is highly recommended to avoid performing invasive procedures in COVID-19 subjects to prevent the potential for dissemination of the pathogen. Treatment consists in particular of respiratory support and symptom relief. Dexamethasone is widely used with encouraging response. There were no cases in the literature that were diagnosed with positive reverse transcription-polymerase chain reaction (RT-PCR) testing only from fluid of involved organs, while repeated nasopharyngeal swabs returned negative for COVID-19. We here describe a case of COVID-19 that presented with moderate-severe pulmonary involvement, diagnosed by RT-PCR testing from bronchoalveolar lavage, while several nasopharyngeal swabs were consistently negative. The patient experienced no improvement under widespectrum antibiotics administered initially, and greatly improved after receiving systemic corticosteroids. One can realize from our case that COVID-19 could not be ruled out upon repeated negative RT-PCR nasopharyngeal swabs, and in subjects with highly suspected COV-ID-19, it is justified to perform invasive procedures, but still using maximal protective measures.

Current molecular diagnostics assays for SARS-CoV-2 and emerging variants

“…Even when multiple tests are administered, false negatives still impact PCR testing results. A case study featured a 63-year old female with symptoms of COVID-19 who repeatedly tested negative for the virus via a nasopharyngeal swab ( Shukha, Makhoul, Abu-Elhija, Hayek, & Hamoud, 2021 ). Upon testing her for COVID-19 using a sample acquired during a bronchoscopy, the results came back positive for COVID-19, and those results were followed by even more negative results from the nasopharyngeal RT-PCR diagnostic.…”