A new positive SARS-CoV-2 test months after severe COVID-19 illness: reinfection or intermittent viral shedding?

Abstract

We present a case of a patient who had a history of severe coronavirus disease (COVID-19) 4 months prior to this current presentation and, after a long asymptomatic period, subsequently tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by a RNA PCR assay, after several interval negative SARS-CoV-2 RNA tests. We present this potential case of SARS-CoV-2 reinfection in order to incite discussion around differentiating persistent infection with intermittent viral shedding and reinfection, as well as to discuss evolving knowledge and approaches to the clinical management, follow-up molecular testing and treatment of COVID-19 reinfection.

Keywords: COVID-19; immunology; pneumonia (infectious disease).

Figure 1

(A) Chest X-ray on the initial presentation with severe COVID-19 (4 months prior to index hospitalisation). (B) Chest X-ray on the second hospitalisation when the patient developed shortness of breath and hypoxia with a positive SARS-CoV-2 RNA test after four interval negative SARS-CoV-2 RNA tests. (C) Chest x-ray on the third hospitalisation when the patient presented with shortness of breath and persistent SARS-CoV-2 RNA positivity.