Prolonged SARS-CoV-2 RNA detection in nasopharyngeal RT-PCR test in COVID-19 patients with Myelodysplastic Syndrome: A case report

Prolonged SARS-CoV-2 RNA detection in nasopharyngeal RT-PCR test in COVID-19 patients with Myelodysplastic Syndrome: A case report

Dr. Hasan Dirik

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: hsndrk_38@hotmail.com

Dr. Şerife Bektaş

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: serifegbektas@gmail.com

Dr. Mehmet Eren Yüksel

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. e-mail: doctormehmeteren@yahoo.com

Prof. Dr. Seval İzdeş

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. E-mail: sevalizdes@yahoo.com

Introduction:The detection of viral ribonucleic acid using reverse transcription polymerase chain reaction (RT-PCR) within nasopharyngeal swabs is essential for the diagnosis of SARS-CoV-2 infection. Myelodysplastic syndrome (MDS) represents a heterogeneous group of myeloid neoplasms which are characterized by ineffective hematopoiesis, cytopenia, and risk of progression to acute myeloid leukemia. Hereby, we present a 62-year-old female patient with both MDS and Covid-19, who continued to have a positive nasopharyngeal RT-PCR test for 46 days until she passed away.

Case Report: The patient, who was diagnosed with MDS in August 2020, was complaining of high fever. She had had two doses of Sinovac vaccine. Past medical history was remarkable for chemotherapy which was ended 1 month before. Bone marrow transplantation was planned within a week. Despite the i.v. ertapenem treatment, high fever persisted, and neutropenia occurred. White blood cell count (Wbc) was 0.43 x109/L. Blood and urinary cultures revealed extended spectrum beta-lactamase (ESBL) producing Escherichia coli. In addition, SARS-CoV-2 RT-PCR test on nasopharyngeal swab was performed, which was revealed to be positive. Antibiotic treatment was initiated. The patient was admitted to the intensive care unit. Afterwards, serial nasopharyngeal swabs were collected from the patient for 46 days until she passed away, and all were positive for Covid-19.

Discussion: In the medical literature, long-term (longer than 3 weeks) SARS-CoV-2 RT-PCR positivity has been reported in mild or asymptomatic patients. There are a few number of publications dealing with MDS and Covid-19 in the English medical literature. Qing et al. reported MDS in a 30-year-old man with Covid-19, however, RT-PCR positive period was not mentioned. SARS-CoV-2 clearance period depends on immunity of the patients and Covid-19 infection may have  a prolonged course in patients with hematological disorders such as MDS.

References

1. Platzbecker U, Kubasch AS, Hom:er-Bouthiette C, Prebet T. Current challenges and unmet medical needs in myelodysplastic syndromes. Leukemia. 2021;35(8):2182-98.

2. Kim SM, Hwang YJ, Kwak Y. Prolonged SARS-CoV-2 detection and reversed RT-PCR results in mild or asymptomatic patients. Infect Dis (Lond). 2021;53(1):31-7.

3. Bhattacharya B, Kumar R, Meena VP, Soneja M, Singh A, Das R, et al. SARS-CoV-2 RT-PCR profile in 298 Indian COVID-19 patients: a retrospective observational study. Pathog Dis. 2021;79(1).

4. Xu W, Piper-Vallillo AJ, Bindal P, Wischhusen J, Patel JM, Costa DB, et al. Time to SARS-CoV-2 clearance among patients with cancer and COVID-19. Cancer Med. 2021;10(5):1545-9.

5. Qing X, Cai J, Rock A. Myelodysplastic syndrome in a 30-year-old man with coronavirus disease 2019 (COVID-19): a diagnostic challenge. Autops Case Rep. 2021;11:e2021274.

Conference: 2. International Cancer Days, Sivas Cumhuriyet University, 16-18 September 2021

https://kansergunleri.cumhuriyet.edu.tr/?page_id=589&lang=tr