Diagnosis of COVID-19 pneumonia despite missing detection of viral nucleic acid and initially inconspicuous radiologic findings

Journal of Medical Virology
Martin SchillerWolfgang Kick

Abstract

The diagnosis of coronavirus disease 2019 (COVID-19) is mainly based on a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result. PCR samples are obtained from upper or lower respiratory tract specimens. However, the sensitivity of PCR is known to have some limitations. We report on a patient who was admitted to our hospital with dyspnea, fever, cough, and history of contact with a SARS-CoV-2 infected relative. The initial chest computed tomography (CT) showed only minimal changes and SARS-CoV-2 PCR from a nasopharyngeal swab sample was negative. PCR results obtained from further nasopharyngeal swabs, qualified sputum samples, and from a lower respiratory tract specimen also remained negative. At day 13 after admission, a second chest CT showed radiological findings suspicious for viral pneumonia. Finally, serologic results showed high levels of immunoglobulin G and immunoglobulin A antibodies against the S1 domain of the SARS-CoV-2 spike protein, and the patient was diagnosed with COVID-19 pneumonia.

References

Feb 8, 2020·JAMA : the Journal of the American Medical Association·Dawei WangZhiyong Peng
Mar 21, 2020·Emerging Microbes & Infections·Michael J Loeffelholz, Yi-Wei Tang
Apr 1, 2020·The Lancet Infectious Diseases·Francois-Xavier LescureYazdan Yazdanpanah
Apr 9, 2020·Japanese Journal of Radiology·Hao FengJianquan Zhong
Apr 10, 2020·Journal of Medical Virology·Ai Tang XiaoSheng Zhang
Apr 22, 2020·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·Xiong WangZiyong Sun
Aug 28, 2020·Journal of Community Hospital Internal Medicine Perspectives·Martin SchillerWolfgang Kick

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Citations

Dec 11, 2020·Journal of Medical Virology·Chloé DimeglioJacques Izopet

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