The Brief Case: “Not Positive” or “Not Sure”—COVID-19-Negative Results in a Symptomatic Patient
Year: 2020
Type: article
Study design: Case Report
Abstract: CASEA previously healthy 35-year-old male presented to our hospital in mid-March 2020 with an acute subarachnoid hemorrhage (SAH).The patient had been in the shower when he experienced a sudden, pounding frontal headache associated with nausea and vomiting, blurred vision, and weakness.Initial imaging confirmed the presence of an SAH; follow-up computerized tomography angiography did not identify an aneurysm or other cause for the SAH.The patient's mental status and oxygenation rapidly deteriorated.He required intubation to protect his airway and was transferred to the intensive care unit (ICU) on hospital day zero (HD0).Given the increasing incidence of coronavirus disease 2019 (COVID-19) at the time and a documented COVID-19 exposure at the patient's place of work 2 days prior to admission, the clinical team was concerned that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was a potential cause of his respiratory failure.It was not believed that the SAH was secondary to COVID-19, though infection prevention measures were initiated upon admission and a nasopharyngeal (NP) swab was submitted from the ICU for molecular testing.The analysis was performed in our hospital microbiology lab utilizing the Quidel Lyra SARS-CoV-2 molecular assay and reported a negative result.He was extubated on HD1 and initially did well from the pulmonary standpoint while his SAH was under investigation.However, he developed diarrhea and mild elevations in his liver enzymes on HD7; chest imaging identified new bilateral airspace opacities, although the patient did not appear symptomatic from these.A second COVID-19 test was performed and was negative.On HD9, the patient became tachypneic and complained of worsening dyspnea.Chest X-ray confirmed bilateral pulmonary infiltrates concerning for COVID-19; thus, elective intubation was performed along with repeat molecular testing that was once again negative for SARS-CoV-2.He had a respiratory pathogen panel (RPP) (BioFire FilmArray Respiratory Panel 2.0) performed that was positive for rhinovirus/enterovirus and coronavirus 229E.Inflammatory markers were not assessed during the first week of hospitalization, but the patient exhibited marked elevations from HD8 onwards.C-reactive protein on HD8 and HD10 measured at 245.5 and 280.5 mg/liter (reference [Ref] Յ10 mg/liter), respectively, and d-dimers ranged from 794 and 3607 ng/ml between HD9 and HD16 (Ref Յ499 ng/ml FEU [fibrinogen equivalent units]).The patient was monitored by the infectious disease team throughout his hospital stay and was continued on COVID-19 isolation precautions despite multiple negative tests.Specifically, he had a total of four negative NP swab results (all performed by the Quidel Lyra assay), submitted on HD1, HD7, HD9, and HD14.He underwent a bronchoalveolar lavage (BAL) on HD15, and a portion of this specimen was sent to a reference laboratory for SARS-CoV-2 testing.A RPP was repeated on the BAL fluid Citation
Source: Journal of Clinical Microbiology
DOI: 10.1128/jcm.01195-20
Institution: Washington University in St. Louis
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3045235409