A COVID-19 patient with multiple negative results for PCR assays outside Wuhan, China: a case report

Abstract

Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency of major international concern. Real-time RT-PCR assays are recommended for diagnosis of COVID-19. Here we report a rare case of COVID-19 with multiple negative results for PCR assays outside Wuhan, China. Case presentation: A 32-year old male was admitted to our hospital because of 6 days of unexplained fever on January 29, 2020. He had come from Wuhan city 10 days before admission. Five days before admission, no abnormality was noted in laboratory test, chest radiography, and nasopharyngeal swab test for the SARS-CoV-2 nucleic acid. The patient was treated with ibuprofen for alleviating fever. On admission, chest computed tomography showed multiple ground-glass opacities in right lower lung field. COVID-19 was suspected. Three times of nasopharyngeal swab specimens were collected after admission. However, none of the specimens were positive. The patient was confirmed with COVID-19 after fifth SARS-CoV-2 nucleic acid test. He was treated with lopinavir/ ritonavir, recombinant human interferon alfa-2b inhalation, methylprednisolone. After 18 days of treatment, he was discharged with improved symptoms, lung lesions and negative results of nasopharyngeal swab. Conclusion: This case reminds clinician that a patient with high clinical suspicion of COVID-19 but multiple negative RT-PCR result should not be taken out of isolation. A combination of patient's exposure history, clinical manifestations, laboratory tests, and typical imaging findings plays a vital role in making preliminary diagnosis and guide early isolation and treatment. Repeat swab tests are helpful in diagnosis for this kind of patients.

Management of severe COVID-19 patient with negative RT-PCR for SARS-CoV-2: Role of clinical, radiological, and serological diagnosis

“…False-negative RT-PCR results have been attracted significant attention recently in many reports. [ 6 , 7 , 10 , 17 ] The sensitivity of the RT-PCR assay is dependent on viral load with peak levels occurring on day 4 based on virological studies. The reliability of the test is limited by the timing of sample collection with regards to symptom onset and user technique with nasopharyngeal swabs.…”

“… [6] The false-negative PCR result has been pushed significant attention and confused the clinicians as final diagnosis relies on RT-PCR positivity for the presence of SARS-CoV-2 in sufficient quantify. [ 7 , 8 , 9 ]…”

SARS-CoV-2 Detection in Fecal Sample from a Patient with Typical Findings of COVID-19 Pneumonia on CT but Negative to Multiple SARS-CoV-2 RT-PCR Tests on Oropharyngeal and Nasopharyngeal Swab Samples

“…Several researchers pointed out the importance of chest CT in presence of negative SARS-CoV-2 RT-PCR tests results, especially in the pandemic context, where the risk of underestimating the disease can increase the risk of virus transmission among individuals [ 9 , 20 , 21 , 22 ]. The Fleishner Society guidelines [ 8 ] suggests that chest imaging can be helpful in the patients triage in the presence of high pre-test probability.…”

COVID-19 re-infection or persistent infection in patient with acute myeloid leukaemia M3: a mini review

“…The latter may be diagnosed with a positive PCR test in which it could be sample contamination or misdiagnosis due to detecting non-infectious RNA. The PCR test cannot differentiate between infectious and non-infectious RNA, so not all test positives will be a clinical relapse [ [15] , [16] , [17] , [18] ]. Lancman et al.…”