Reactivation of SARS-CoV-2 after Asymptomatic Infection while on High-Dose Corticosteroids. Case Report
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COVID-19
Reactivation of SARS-CoV-2 after Asymptomatic Infection while on High-Dose Corticosteroids. Case Report Rita Patrocínio de Jesus 1 & Raquel Silva 2 & Elzara Aliyeva 3 & Luís Lopes 4 & Mihran Portugalyan 4 & Liliana Antunes 2 & Priscila Diaz 2 & Carolina Costa 2 & Ana Carolina Araújo 2 & Sílvia Coelho 2 & João João Mendes 2 & Sara Gomes 2 & Isabel Serra 2 & Paulo Freitas 2 Accepted: 23 September 2020 # Springer Nature Switzerland AG 2020
Abstract As SARS-CoV-2 and its related clinical syndrome (COVID-19) became a pandemic worldwide, questions regarding its clinical presentation, infectivity, and immune response have been the subject of investigation. We present a case of a patient previously considered recovered from nosocomially transmitted asymptomatic COVID-19 illness, who presented with new respiratory, radiological, and RT-PCR findings consistent with COVID-19, while on high-dose prednisolone due to a suspected secondary demyelinating disease. Importantly, it led to three subsequent cases within patient’s household after discharge from the hospital. After reviewing this case in light of current evidence and debates surrounding SARS-CoV-2 RT-PCR results, we hypothesize that patients on corticosteroids may have particular viral shedding dynamics and should prompt a more conservative approach in regard to isolation discontinuation and monitoring. Keywords COVID-19 . RT-PCR . Viral shedding . Corticosteroids . Case report
Introduction
Case Report
Since the identification of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the cause of the disease which was later named COVID-19, and as it progressed to the current worldwide pandemic, much investigation has been made regarding its clinical presentation, transmission route, and immunity. Here, we present an atypical case regarding clinical evolution and SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) dynamics and discuss it in light of the current published evidence.
We report the case of a 41-year-old with no relevant underlying medical conditions who was admitted to our hospital on June 15 due to a 10-day history of gait ataxia, dizziness, headache, and vomiting. On admission, he was screened for COVID-19 as a standard procedure for hospitalized patients (BD MAX™ System: negative SARS-CoV-2 RT-PCR). Thorough diagnostic workup raised the suspicion of a secondary demyelinating disease, and the patient was started on highdose steroids (methylprednisolone 1 g/day for 3 days followed by prednisolone 1 mg/Kg/day) (Fig. 1). On June 21, a patient who had been admitted for a bilateral pneumonia (with two negative tests for SARS-CoV-2) and was sharing the same room was intubated as an emergency in the context of a cardiopulmonary arrest, with a subsequent post-mortem nasopharyngeal and oropharyngeal swab revealing SARS-CoV-2 RNA. Hence, our patient collected a swab on the 23rd of June as screening, which proved to be positive (QuantStudio™ 7 Flex RT PCR system: N1 Ct 35.8, N2 Ct 37.3, RP Ct 29). He was moved to a COVID-19
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