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Recurrence of COVID-19 after recovery: a case report from Italy
Infection ( IF 7.5 ) Pub Date : 2020-05-16 , DOI: 10.1007/s15010-020-01444-1
Daniela Loconsole 1 , Francesca Passerini 2 , Vincenzo Ostilio Palmieri 2 , Francesca Centrone 1 , Anna Sallustio 3 , Stefania Pugliese 2 , Lucia Donatella Grimaldi 2 , Piero Portincasa 2 , Maria Chironna 1
Affiliation  

Since the diffusion of SARS-CoV-2 infection outside China, Italy became one of the world’s worst-affected country. By May 3, 2020, recorded cases in Italy were 210,717, with 28,884 deaths and 81,654 recovered cases. Here, we describe a case of reactivation of COVID-19 registered in Italy at the beginning of May 2020. On March 17, a 48-year-old man visited the Emergency Department, Policlinico Hospital of Bari, Puglia region (Italy), with fever, cough and shortness of breath, hyporexia for 6 days (Fig. 1). Physical examination revealed normal vital signs but because of 90% oxygen saturation on ambient air, the patient was promptly treated with O2 6 lt/min (Venturi Mask 31%). The patient did not report any underlying medical condition such as diabetes, hypertension, or cardiovascular disease. For the suspicion of COVID-19, he was immediately admitted to the “grey zone” of internal medicine, at the “Asclepios” COVID-Hospital, Policlinico. The chest X-ray showed a pneumonia (bilateral multiple thickenings with badly defined margins with consolidation aspects more evident on the right side). The real-time PCR on the nasopharyngeal swab collected on March 18 revealed the presence of SARS-CoV-2. The virus was detected by a real-time PCR assay targeting E-gene, RdRP-gene and N-gene, performed with the protocol previously reported by the WHO (https ://www.who.int/docs/defau lt-sourc e/ coron aviru se/uscdc rt-pcr-panel -for-detec tion-instr uctio ns.pdf?sfvrs n=3aa07 934_2). Based on the criteria of Wang et al. (2020), the patient had a severe form of the disease due to the presence of fever, respiratory symptoms, radiological signs of pneumonia and PaO2/FiO2 < 300 mmHg [1]. He was treated with O2 at different volumes (up to 60% FiO2 VM), lopinavir/ritonavir (200/50 mg, 2 tablets × 2/day), hydroxychloroquine (400 mg b.i.d on the first day, and 200 mg b.i.d afterwards), enoxaparin 6000 IU b.i.d., methylprednisolone (starting dose 40 mg b.i.d, lately tapered). At the checkup after 6 days, the chest X-ray showed a slight improvement involvement. After 14 days the patients became afebrile and his respiratory symptoms disappeared. The chest X-ray showed only blurred areas of parenchymal thickening. Our hospital required two consecutive negative SARS-CoV-2 molecular tests, plus normal body temperature, resolution of respiratory symptoms, with the improvement of lung imaging. The two nasopharyngeal swabs collected on March 30 and 31 were both negative for SARS-CoV-2 infection. The patient was therefore discharged and encouraged to maintain home quarantine for at least 14 days. The molecular test was also negative at his follow-up visit on April 15, suggesting that the patient was cured from COVID-19. In addition, two serological assays (VivaDiagTM, VivaChek Laboratories, INC, USA and Anti SARS-CoV-2 ELISA IgG Test, Euroimmun, Lubeck, Germany) revealed the presence of IgM and IgG anti-SARS-CoV-2. However, on April 30, he developed new symptoms, i.e., dyspnea and chest pain. He visited again the Emergency Department where he was re-admitted to the same ward with a suspicion of a pulmonary embolism that was confirmed by CT scan. The imaging showed the presence of segmental and sub-segmental signs of arterial microembolism with some parcel area of ground glass. Because of his recent clinical history, a SARS-CoV-2 molecular test was performed and proved to be positive. Moreover, serological assay revealed the presence of only IgG anti-SARS-CoV-2. To date, the patient is well, on anticoagulant therapy and does not require O2 supplementation. * Maria Chironna maria.chironna@uniba.it
更新日期:2020-05-16
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