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Dtsch Med Wochenschr 2020; 145(20): 1498-1502
DOI: 10.1055/a-1202-3936
Kasuistik

Vierfach negative SARS-CoV-2-PCR – dennoch COVID-19-Pneumonie!

Quadruple negative SARS-CoV-2-PCR: still COVID-19 pneumonia!
Alexandra Dubbke-Laule
1   Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland, Strausberg
,
Manuela Gnauck
1   Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland, Strausberg
,
Ralf Straub
2   Praxis für Radiologie, Strausberg
,
Frank Berthold
3   IMD Labor Oderland, Frankfurt/Oder
,
Christian Jenssen
1   Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland, Strausberg
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Zusammenfassung

Anamnese und klinischer Befund Ein 78-jähriger Mann erkrankte Anfang April 2020 19 Tage nach einer Kreuzfahrt mit Schwäche, Husten und Fieber und wurde 4 Tage später mit zunehmender Luftnot vorstellig.

Untersuchung und Diagnose Bei Aufnahme bestanden subfebrile Temperaturen, Belastungsdyspnoe und rechtsbasale Rasselgeräusche. Das CRP war mäßig erhöht und die Sauerstoffsättigung gering reduziert. Im Thorax-CT fanden sich bilaterale Milchglasinfiltrate. Unmittelbar nach der Kreuzfahrt war ein nasopharyngealer Abstrich auf SARS-CoV-2 negativ.

Therapie und Verlauf In Kenntnis der Tatsache, dass die symptomfreie Ehefrau des Patienten unmittelbar nach Rückkehr von der Kreuzfahrt positiv auf SARS-CoV-2 getestet worden war, gingen wir von einer COVID-19-Erkrankung aus und hospitalisierten den Patienten. Zwei nasopharyngeale Abstriche und die Bronchiallavage ergaben negative Befunde für SARS-CoV-2, die Diagnose COVID-19 wurde letztlich serologisch verifiziert.

Folgerung Bei hochgradigem klinisch-anamnestischem Verdacht in Verbindung mit typischen Befunden der Thorax-Bildgebung sollte die Verdachtsdiagnose COVID-19 auch im Falle mehrfach negativer SARS-CoV-2-PCR aufrechterhalten bleiben. Die Serokonversion tritt einige Tage bis 2 Wochen nach Symptombeginn auf und kann im Verlauf zur endgültigen Diagnosesicherung genutzt werden.

Abstract

Medical history and clinical findings A 78-year-old man fell ill with weakness, coughing and fever 19 days after a cruise in early April 2020 and was admitted 4 days later with increasing shortness of breath.

Examination and diagnosis On admission, the patient had subfebrile temperatures, exercise dyspnea, and right-basal rales. CRP was moderately elevated and oxygen saturation was slightly reduced. Thoracic CT showed bilateral ground-glass infiltrates. Immediately after the cruise a nasopharyngeal swab was negative for SARS-CoV-2.

Therapy and course Due to the fact that the patient’s asymptomatic wife had been tested positive for SARS-CoV-2 immediately after returning from the cruise, we suspected COVID-19 disease and admitted the patient to our isolation ward. Two nasopharyngeal swabs and bronchial lavage yielded negative results for SARS-CoV-2. Finally, suspected COVID-19 diagnosis was verified serologically.

Conclusion In case of a high degree of clinical suspicion in combination with typical findings of thoracic imaging, the suspected diagnosis COVID-19 disease should be maintained even in case of multiple negative SARS-CoV-2-PCR. Seroconversion occurs a few days to 2 weeks after the onset of symptoms and can be used to confirm the diagnosis.

Schlüsselwörter

COVID-19 - SARS-CoV-2 - Computertomografie - PCR - Serokonversion

Key words

COVID-19 - SARS-CoV-2 - computed tomography - PCR - seroconversion


Publication History

Article published online:
31 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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