Prolonged SARS-Cov-2 shedding with rapid IgG antibody decay in a COVID-19 patient: A case report

Abstract

Background: The coronavirus disease 2019 (COVID-19) epidemic is still spreading rapidly around the world. Recent cases with prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection have been successively reported, and the phenomenon of false-negative real-time polymerase chain reaction (RT-PCR) results of SARS-CoV-2 RNA or “repositive” was also described in COVID-19 patients. Methods: We report a 69-year-old female patient with hypertension, suspected lung tumor, and previous history of total hysterectomy for hysteromyoma who presented with moderate COVID-19 symptoms and was positive for SARS-CoV-2 RNA by RT-PCR when she traveled from the USA to China. Results: The patient required second and third re-hospitalizations due to “repositive” SARS-CoV-2 throat swab test results during post-charge solitary isolation and observation, and serum SARS-CoV-2-IgG decayed rapidly before disappearing on illness Day 139 when the throat swab was still positive. The virus shedding lasted for at least 146 days (the last positive throat swab test result was on illness Day 146, and the first true-negative test result was on illness Day 151) since her initial positive test. Conclusion: Prolonged SARS-CoV-2 RNA viral shedding is prone to occur in an immunocompromised host, wherein changes in the host immune status can lead to repeated positive SARS-CoV-2 detection. Moreover, the SARS-CoV-2-IgG may decrease rapidly and disappear before virus removal, indicating there may be certain limitations on the protective effect of the SARS-CoV-2 antibody, which deserves clinical attention.