Difficulties in diagnosing the severe coronavirus disease COVID-19 with a negative PCR test result

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Abstract

The clinical case in this article describes the topic of current interest concerning the diagnostic methods for coronavirus disease (COVID-19). The diagnostic process was hindered by nonspecific initial symptoms and twice negative results of the PCR test. For the next several days, the worsening in dynamics was observed in terms of symptoms and laboratory test results, specific to acute kidney injury, hypercoagulability syndrome and multiple organ failure. Ongoing monitoring of lungs via computed tomography revealed the typical for COVID-19 image of lungs (including ground-glass opacity and pulmonary consolidation). With suspected coronavirus disease the patient’s sample was transferred to the University research laboratory for a serologic test to detect IgG antibodies. The positive result of the test confirmed that the patient had COVID-19. The prescribed anticoagulants and glucocorticosteroids improved the condition. The described clinical case acknowledges the complexity of the PCR test, therefore full investigation and other tests are recommended in the case of suspected coronavirus disease.

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About the authors

Saida R. Kharisova

Kazan (Volga region) Federal University

Author for correspondence.
Email: saida.musaeva.r@gmail.com
ORCID iD: 0000-0001-5668-2408

MD

Russian Federation, Kazan

Emma I. Mukhametshina

University Clinic of Kazan (Volga region) Federal University

Email: emmaim@mail.ru
ORCID iD: 0000-0002-9778-8302

MD

Russian Federation, Kazan

Sayar R. Abdulkhakov

Kazan (Volga region) Federal University; University Clinic of Kazan (Volga region) Federal University

Email: sayarabdul@yandex.ru
ORCID iD: 0000-0001-9542-3580
SPIN-code: 4131-8360

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Kazan; Kazan

Raushaniia F. Gaifullina

Kazan (Volga region) Federal University; University Clinic of Kazan (Volga region) Federal University

Email: RFGajfullina@kpfu.ru
ORCID iD: 0000-0002-0922-5850
SPIN-code: 9614-8375

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Kazan; Kazan

References

  1. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323(18):1843–1844. doi: 10.1001/jama.2020.3786
  2. Long QX, Liu BZ, Deng HJ, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med. 2020;26(6):845–848. doi: 10.1038/s41591-020-0897-1
  3. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19. J Infect. 2020;80(6):607–613. doi: 10.1016/j.jinf.2020.03.037
  4. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847. doi: 10.1111/jth.14768
  5. Povalyaev D. The efficacy of adjuvant use low molecular weight heparins in patients with community-acquired pneumonia. Eur Respir J. 2014;44(Suppl. 58):2503.
  6. Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094–1099. doi: 10.1111/jth.14817

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. Dynamics of lung changes according to computed tomography data: a — computed tomography of the chest organs April 23, 2020 without contrast enhancement: focal infiltrative changes in the right lung; b — computer tomo-X-ray of the chest organs dated May 7, 2020 with contrast enhancement: bilateral polysegmental interstitial changes in the lungs with separate foci of compaction at the level of the lower lobe on the right; c — computed tomography of organs chest from May 19, 2020 with contrast enhancement: bilateral subtotal interstitial-alveolar lesion lungs with increasing intensity, polysegmental consolidation of the lower lobe of the left lung at the level of S8–10.

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