An atypical case: RT-PCR-negative, sero-positive covid-19 patient

William Suriady; Andika Chandra Putra; Wiwien Heru Wiyono; Mohammad Fahmi Alatas; Bettia Bermawi; Ratna Moniqa; Hendra Koncoro; Laurentius Aswin Pramono; Fransiska; Maria Edith Sulistio; Ramzi; Robert Sinto; Rachmat Hamonangan; Adi Surya Komala; C. Krismini Dwi Irianti; J.B. Endrotomo Sumargono

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An atypical case: RT-PCR-negative, sero-positive covid-19 patient

Pneumologia

Volume 69 (2020): Issue 2 (December 2020)

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Published Online: Dec 31, 2020

Page range: 107 - 114

DOI: https://doi.org/10.2478/pneum-2020-0013

Keywords
COVID-19, SARS-CoV-2, RT-PCR, atypical case, sero-positive

© 2020 William Suriady et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

A–E, consecutively: chest X-ray progression and follow-up image on first visit to outpatient clinic, Day 1, Day 9, Day 16 and Day 23 of hospitalisation.

CT scan of chest, taken on the 17th day of hospitalisation.

Vital sign, symptoms and examination by day of illness and hospitalisation

	1^st Visit	Day 1 (admission)	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Day 8	Day 9	Day 10	Day 11	Day 12	Day 13	Day 14	Day 15	Day 16	Day 17	Day 18	Day 19	Day 20	Day 21	Day 22	Day 23	Day 24	Day 25
Cough	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	(+), dry	±	±	±	±	(−)	(±)	(+), dry	(+), dry	x	x
Dyspnoea	(−)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	±	±	-	-	-	(−)	(−)	(+)	(+)	x	x
Fever	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(−)	(+)	(−)	(+)	(−)	(−)	(+)	(+)	(+)	(+)	(+)
RR	20	36	24	24	22	22	22	24	26	25	25	20	24	18	22	20	22	19	22	20	22	21	32	32	26	25
SaO₂	98%	83%	95%	97%	98%	93%	98%	93%	98%	99%	99%	99%	96%	97%	98%	99%	95%	94%	98%	95%	100%	97%	94%	86%	96%	97%
Physical examination	(−)	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi ±/±	Rhonchi ±/±	Rhonchi ±/±	Rhonchi ±/±	Rhonchi ±/±	Rhonchi ±/±	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+	Rhonchi +/+
Oxygenation	(−)	NRM 12 L/min	NRM 15 L/min	NRM 15 L/min	NRM 15 L/min	NRM 10 L/min	NIPPV 60 L/min	NIPPV 60 L/min	NIPPV 60 L/min	NIPPV 60 L/min	NIPPV 60 L/min	NIPPV 40 L/min	NRM 15 L/min	NRM 15 L/min	NRM 10 L/min	NRM 10 L/min	NC 3 L/min	NC 3 L/min	NC 3 L/min	NC 4 L/min	NC 2 L/min	NC 2 L/min	NRM 10 L/min	PC 15, PEEP 8, RR 20 FiO₂ 100%	PC 10, PEEP 8, RR 15 FiO₂ 90%	PC 15, PEEP 10, RR 30 FiO₂ 100%
Laboratory values	CBCEos 0.0 (↓)CRP 43 (↑)	CBCEos 0.1 (↓)Lym 11.6 (↓)Neut 80.9 (↑)CRP 40 (↑)Ur 36Crea 1.2 (↑)eGFR 46.2 (↓)Glob 4.04 (↑)BilD 0.34 (↑)BilI 0.16 (↓)AST 104 (↑)ALT 74 (↑)GGT 187 (↑)LDH 1,054 (↑)Ferr 1,387.62 (↑)	FPG 212 (↑)PPG 243 (↑)RT-PCRNP (-)OP (-)(Result obtained on Day 8)	PPG 167 (↑)			ABGpH 7.45pCO₂ 26.7 (↓)PaO₂ 75 (↓)HCO₃ 18.9 (↓)BE -3.50SaO₂ 96.30Temp 36.7FiO₂ ~100		RT-PCRNP (-) (Result obtained on Day 17)	FPG 126PPG 86			FPG 516 (↑)PPG 309 (↑)	FPG 227 (↑)PPG 241 (↑)	FPG 339 (↑)PPG 170 (↑)	FPG 159 (↑)	FPG 321 (↑)PPG 53 (↑)	CBCLeu 13.71 (↑)Bas 0.2 (↓)Eos 0.0 (↓)Mon 4.5 (↓)Lym 3.6 (↓)Neut 91.7 (↑)	CRP 298 (↑)Proc 0.5FPG 108 (↑)PPG 158 (↑)	Rapid AbIgM (+)IgG (+)	RPG427-204-342RT-PCRNP (-)OP (-)(Result on Day 21)	FPG 140 (↑)PPG 273 (↑)	CBCHb 10.5 (↓)Leu 15.52 (↑)Eos 0.2 (↓), Mon 3.5 (↓)Lym 4.4 (↓), Neut 91.5 (↑)CRP 334 (↑)FPG 150 (↑), PPG 135UrinalysisSlightly opaqueProtein 1+ (↑), Blood 2+ (↑)Leucocyte esterase 2+ (↑)Epithelial cells 4 (↑)Leucocyte 18 (↑)Erythrocyte 10 (↑)Blood cultureYeast cells (+)(Result on Day 24)	PT 11.5 (↑)D-dimer 7,660 (↑↑)Ur 71 (↑), Crea 1.7 (↑)eGFR 30.3 (↓)Kalium 5.8 (↑)Proc 2 (↑)Alb 2.07, Glob 3.94BilTot 1.22 (↑)BilD 0.69 (↑)AST 44 (↑)GGT 163 (↑), AF 231 (↑)ABGpH 7.33 (↓)pCO₂ 33.0, PaO₂ 136 (↑)HCO₃ 17.3 (↓)BE -6.70SaO₂ 99.20Temp 38.6FiO₂ 100	CBCHb 8.8 (↓)Leu 24.63 (↑)Eos 0.2 (↓), Mon 3.5 (↓)Lym 7.2 (↓)Neut 88.8 (↑)aPTT 45.7 (↑)Chloride 116 (↑)RPG211-102ABGpH 7.37pCO₂ 27.0, PaO₂ 77 (↑)HCO₃ 15.9 (↓)BE -7.40SaO₂ 95.40Temp 37.0FiO₂ 90	aPTT 68.6 (↑)RPG208-175-353-117ABG (1st)pH 6.97pCO₂ 99.4 (↑), PaO₂ 106 (↑)HCO₃ 23.1BE -9.40SaO₂ 93.00Temp 38.3FiO₂ 100ABG (2nd)pH 6.97pCO₂ 89.5 (↑), PaO₂ 150 (↑)HCO₃ 21.1BE -10.40SaO₂ 97.70Temp 36.5FiO₂ 100
Imaging	CXR Infiltrates in left perihilar and bilateral laterobasal areas	CXR Bilateral paracardiac infiltrate					CXR Decrease in perihilar and paracardiac infiltrates		CT Bilateral GGO suggestive of viral pneumonia	CXR Increased infiltrates in bilateral perihilar and paracardiac regions														CXR Increased pulmonary infiltrate in both lungs

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An atypical case: RT-PCR-negative, sero-positive covid-19 patient

Article Category: Clinical Cases

Published Online: Dec 31, 2020

Page range: 107 - 114

DOI: https://doi.org/10.2478/pneum-2020-0013

Keywords
COVID-19, SARS-CoV-2, RT-PCR, atypical case, sero-positive

© 2020 William Suriady et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Figure 2

Vital sign, symptoms and examination by day of illness and hospitalisation

An atypical case: RT-PCR-negative, sero-positive covid-19 patient

Article Category: Clinical Cases

Published Online: Dec 31, 2020

Page range: 107 - 114

DOI: https://doi.org/10.2478/pneum-2020-0013

KeywordsCOVID-19, SARS-CoV-2, RT-PCR, atypical case, sero-positive

© 2020 William Suriady et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Figure 2

Vital sign, symptoms and examination by day of illness and hospitalisation

Keywords
COVID-19, SARS-CoV-2, RT-PCR, atypical case, sero-positive