Diagnosis of COVID‐19 pneumonia despite missing detection of viral nucleic acid and initially inconspicuous radiologic findings

Schiller, Martin; Wydra, Stephan; Kerl, Hans Ulrich; Kick, Wolfgang

The diagnosis of coronavirus disease 2019 (COVID‐19) is mainly based on a positive SARS‐CoV‐2 polymerase chain reaction (PCR) result. PCR samples are obtained from upper or lower respiratory tract specimens. However, the sensitivity of PCR is known to have some limitations. We report on a patient who was admitted to our hospital with dyspnea, fever, cough and history of contact to a SARS‐CoV‐2 infected relative. The initial chest computed tomography (CT) showed only minimal changes and SARS‐CoV‐2 PCR from a nasopharyngeal swab sample was negative. PCR results obtained from further nasopharyngeal swabs, qualified sputum samples, and from a lower respiratory tract specimen also remained negative. At day 13 after admission, a second chest CT showed radiological findings suspicious for viral pneumonia. Finally, serologic results showed high levels of IgG and IgA antibodies against the S1 domain of the SARS‐CoV‐2 spike protein and the patient was diagnosed with COVID‐19 pneumonia. This article is protected by copyright. All rights reserved.