Positive SARS-CoV-2 RNA recurs repeatedly in a case recovered from COVID-19: dynamic results from 108 days of follow-up

Abstract

The evidence of long-term clinical dynamic on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA re-positive case are less. We performed a 108 days follow-up on dynamic clinical presentations in a case, who hospitalized three times due to the positive recurrence of SARS-CoV-2 RNA after discharge, to understand the prognosis of the 2019-Coronavirus disease (COVID-19). In this case, positive SARS-CoV-2 recurred even after apparent recovery (normal CT imaging, no clinical symptoms, negative SARS-CoV-2 on stool sample and negative serum IgM test) from COVID-19, viral shedding duration lasted for 65 days, the time from symptom onset to disappearance was up to 95 days. Erythrocyte-associated indicators, liver function and serum lipid metabolism presented abnormal throughout during the observation period. Awareness of atypical presentations such as this one is important to prompt the improvement of the management of COVID-19.

Keywords: SARS-CoV-2 re-positive; coronavirus disease 2019; erythrocyte; long-term follow-up; recovered patients.

Figure 1.

Time dynamics of virus, chest radiograph and clinical symptom on a case recovered from COVID-19 during the observation period. LPV: lopinavir; IAI: interferon α2b atomization inhalation; AHG: arbidol hydrochloride granules; MPD: methylprednisolone.

Figure 2.

The temporal changes of laboratory indicators in a patient recovered from COVID-19. HDL-C: high-density lipoprotein cholesterol; ALT: alanine transaminase; AST: aspartate aminotransferase; GGT: gamma-glutamyltransferase; MCH: mean corpuscular hemoglobin; MCV: mean corpuscular volume; RDW: red cell distribution width; RBC: red blood cell count; CRP: rapid c-reactive protein; GFR: glomerular filtration rate; β2-MG: β2-macroglobulin; RR: respiratory rate; CKMB: creatine kinase isoenzyme; LDH: lactate dehydrogenase.