Utility of Ct values in differentiating COVID-19 reinfection versus prolonged viral shedding in an immunocompromised patient

Katherine Julian; Neal Shah; Rashmi Banjade; Dhirisha Bhatt

doi:10.1136/bcr-2021-243692

Utility of Ct values in differentiating COVID-19 reinfection versus prolonged viral shedding in an immunocompromised patient

BMJ Case Rep. 2021 Jul 27;14(7):e243692. doi: 10.1136/bcr-2021-243692.

Authors

Katherine Julian¹, Neal Shah², Rashmi Banjade³, Dhirisha Bhatt⁴

Affiliations

¹ Penn State College of Medicine, Hershey, Pennsylvania, USA kjulian1@pennstatehealth.psu.edu.
² Department of Internal Medicine, Division of Hematology/Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
³ Department of Internal Medicine, Division of Infectious Disease, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
⁴ Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

Abstract

We describe the case of a 26-year-old man who presented to an outside hospital with concerns of blurred vision. He subsequently tested positive for COVID-19 and his lab work suggested acute leukaemia. The patient was admitted to our hospital and completed a course of remdesivir. He eventually tested negative for COVID-19 before initiating chemotherapy. Two days after starting chemotherapy, he developed a neutropenic fever and tested positive for COVID-19. Through this case, we aim to bring attention to patients who recurrently test positive with COVID-19 PCR testing, thereby causing a dilemma of differentiating between reinfections and prolonged shedding of the virus, as well as understand and use cycle threshold values to discern these aetiologies.

Keywords: haematology (incl blood transfusion); infectious diseases.

Publication types

Case Reports

MeSH terms

Adult
COVID-19*
Humans
Immunocompromised Host
Male
Reinfection
SARS-CoV-2
Virus Shedding