[Quadruple negative SARS-CoV-2-PCR: still COVID-19 pneumonia!]

Dubbke-Laule, Alexandra; Gnauck, Manuela; Straub, Ralf; Berthold, Frank; Jenssen, Christian

MEDICAL HISTORY AND CLINICAL FINDINGS A 78-year-old man fell ill with weakness, coughing and fever 19 days after a cruise in early April 2020 and was admitted 4 days later with increasing shortness of breath. EXAMINATION AND DIAGNOSIS On admission, the patient had subfebrile temperatures, exercise dyspnea, and right-basal rales. CRP was moderately elevated and oxygen saturation was slightly reduced. Thoracic CT showed bilateral ground-glass infiltrates. Immediately after the cruise a nasopharyngeal swab was negative for SARS-CoV-2. THERAPY AND COURSE Due to the fact that the patient's asymptomatic wife had been tested positive for SARS-CoV-2 immediately after returning from the cruise, we suspected COVID-19 disease and admitted the patient to our isolation ward. Two nasopharyngeal swabs and bronchial lavage yielded negative results for SARS-CoV-2. Finally, suspected COVID-19 diagnosis was verified serologically. CONCLUSION In case of a high degree of clinical suspicion in combination with typical findings of thoracic imaging, the suspected diagnosis COVID-19 disease should be maintained even in case of multiple negative SARS-CoV-2-PCR. Seroconversion occurs a few days to 2 weeks after the onset of symptoms and can be used to confirm the diagnosis.