Recurrence of COVID-19 related symptoms and viral detection in a patient discharged after complete recovery and test negativization

Chiara Vassallo; Francesca Pupo; Luca Marri; Chiara Schiavi; Francesca Giusti; Monica Greco; Simone Negrini; Raffaele De Palma; Andrea Guastalla

doi:10.4081/itjm.2021.1393

https://doi.org/10.4081/itjm.2021.1393

Chiara Vassallo | chiaravsl@gmail.com Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0001-8723-9863
Francesca Pupo Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0003-1149-888X
Luca Marri Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0003-0614-2950
Chiara Schiavi Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy.
Francesca Giusti Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0001-5517-8074
Monica Greco Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0001-5311-4296
Simone Negrini Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0003-1267-4320
Raffaele De Palma Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy. https://orcid.org/0000-0001-9070-8878
Andrea Guastalla Department of Clinical Immunology, IRCCS-San Martino University Hospital, University of Genoa, Italy.

Abstract

Since the novel coronavirus disease 2019 (COVID-19) has been declared a pandemic, the possibility of recurrence of the disease after recovery has become a debated issue. We report a case of an 84-years-old male patient who was admitted to our hospital for dyspnea and fever. Lab and clinical workout showed that he had COVID-19. After a full recovery of symptoms and a double negative nasopharyngeal swab of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) by realtime polymerase chain reaction assay, he was discharged from the hospital. One month later, he developed dyspnea and fever again with lung involvement. Surprisingly, the nasopharyngeal swab of SARS-CoV-2 was positive. Since he denied contacts with confirmed or suspected cases of COVID-19, he probably experienced a reactivation of a persistent infection. The failed eradication of the virus could depend on both virus’ escape mechanisms and dysfunctional immune response. Further studies are needed to confirm the hypothesis of viral reactivation and identify signs of an incomplete clearance.

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