Delayed positive COVID19 nasopharyngeal test, a case study with clinical and pathological correlation

Area of Science:

• Pulmonology
• Infectious Diseases
• Allergy Immunology

Background:

• Investigating reasons for delayed coronavirus disease 2019 (COVID-19) nasopharyngeal PCR tests.
• Understanding the pathophysiological basis for delayed COVID-19 detection.

Observation:

• A 64-year-old male with asthma, COPD, and diabetes presented with COVID-19 symptoms but had repeatedly negative nasopharyngeal PCR tests and IgG antibodies.
• Elevated serum IgE levels were noted, and symptoms worsened despite standard treatments.
• Bronchoalveolar lavage and lung biopsy revealed COVID-19 RNA positive fibrosing organizing pneumonia with eosinophilic inflammation and airway damage.

Findings:

• Nasopharyngeal PCR tests became positive 40 and 49 days after symptom onset.
• Allergic asthma, high IgE, and corticosteroid inhalation may delay upper airway viral detection.
• COPD-related obstruction and fibrosis contribute to ventilator dependence and poor COVID-19 prognosis.

Implications:

• Targeting allergic asthma, high IgE, and COPD-related fibrosis is crucial for managing COVID-19.
• Considering alternative diagnostic methods beyond nasopharyngeal swabs in specific patient groups.
• Developing targeted therapies for COVID-19 patients with pre-existing respiratory conditions.