Reactivation of SARS-CoV-2 after Asymptomatic Infection while on High-Dose Corticosteroids. Case Report

Patrocínio de Jesus, Rita; Silva, Raquel; Aliyeva, Elzara; Lopes, Luís; Portugalyan, Mihran; Antunes, Liliana; Diaz, Priscila; Costa, Carolina; Araújo, Ana Carolina; Coelho, Sílvia; Mendes, João João; Gomes, Sara; Serra, Isabel; Freitas, Paulo

As SARS-CoV-2 and its related clinical syndrome (COVID-19) became a pandemic worldwide, questions regarding its clinical presentation, infectivity, and immune response have been the subject of investigation. We present a case of a patient previously considered recovered from nosocomially transmitted asymptomatic COVID-19 illness, who presented with new respiratory, radiological, and RT-PCR findings consistent with COVID-19, while on high-dose prednisolone due to a suspected secondary demyelinating disease. Importantly, it led to three subsequent cases within patient’s household after discharge from the hospital. After reviewing this case in light of current evidence and debates surrounding SARS-CoV-2 RT-PCR results, we hypothesize that patients on corticosteroids may have particular viral shedding dynamics and should prompt a more conservative approach in regard to isolation discontinuation and monitoring.