COVID 19 pneumonias with negative rt-PCR testing

ABSTRACT

Background: The COVID 19 pandemic caused by the betacoronavirus SARS-CoV-2 with its virulence and contagiousness is a public health emergency. The prefferred method of diagnosis is the FDA aprroved RT-PCR testing of nasopharyngeal swabs with 65% sensitivity, with false negative rates of <5% to 40%. Clinical diagnosis should supplant when there is high suspicion with labs and imaging consistent with COVID'19 and negative RT-PCR does not rule out the disease. Here we report one such case. Case Report 45-year-old female with nil comorbidities presented with fever and breathlessnesss since 7 days with tachypnoea (46 breaths/min), hypoxia (spo2 75% room air) and bilateral coarse crepitations on auscultation. ABG & CXR suggested severe ARDS. CT Thorax revealed CTSI 21/25.CORADS 5.Two nasopharyngeal swabs 24 hours apart tested negative for COVID'19. Lab investigations suggested deranged inflammatory markers (ferritin 910ng/mL;CRP 121.2ng/L ;D-dimer 660ng/mL). Presumed diagnosis of COVID 19 was established based on early CT findings and lab parameters consistent with COVID'19 Pneumonitis,the patient was immediately isolated and received treatment as per COVID'19 treatment protocols (steroids,LMWH,Remdesivir). After 6th week patient showed clinical and radiological improvement.Subsequently she also developed postcovid fibrosis and discharged on pirfenidone and home based low-flow o2. Discussion and Conclusion: Fever, sore throat and breathlessness are common symptoms of Covid'19, most of which are virtually present in any viral LRTI, however in the setting of current pandemic maintain high index of suspicion for Covid'19 especially in the presence of radiological evidence even with negative RT-PCR.