key: cord-0827170-aed6psww authors: Duggan, Nicole M.; Ludy, Stephanie M.; Shannon, Bryant C.; Reisner, Andrew T.; Wilcox, Susan R. title: A case report of possible novel coronavirus 2019 reinfection date: 2020-07-04 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2020.06.079 sha: fec494dfd16a1654f55cfa34f63487fef4a5f8f2 doc_id: 827170 cord_uid: aed6psww Since December 2019, COVID-19, the clinical syndrome associated with SARS-CoV-2 infection, has infected more than 6.2 million people and brought the function of the global community to a halt. As the number of patients recovered from COVID-19 rises and the world transitions toward reopening, the question of acquired immunity versus the possibility of reinfection are critical to anticipating future viral spread. Here, we present a case of a patient previously recovered from COVID-19 who re-presents with new respiratory, radiographical, laboratory, and RT-PCR findings concerning for re-infection. We review this case in the context of the evolving discussion and theories surrounding dynamic RT-PCR results, prolonged viral shedding, and the possibility of developed immunity. First discovered in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated clinical syndrome (COVID-19) became a global pandemic over a few short months [1, 2] . According to the World Health Organization recommendations, patients infected with COVID-19 may safely discontinue home isolation and are considered non-infectious after complete symptomatic recovery in addition to two negative real-time reverse-transcription polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 drawn at least 24 hours apart [3] . However, recent reports of patients re-testing positive even after resolved symptoms and negative testing raise questions about the possibility of reinfection [4] [5] [6] [7] . Here, we present a case of possible SARS-CoV-2 reinfection, and discuss this case in the context of the existing debate surrounding dynamic RT-PCR results. An 82-year-old male with a history of advanced Parkinson's disease, insulin-dependent diabetes, chronic kidney disease, and hypertension presented to the emergency department (ED) in early-April 2020 with one week of fever and shortness of breath. He was hemodynamically stable, but tachypneic, hypoxic to 89% on six liters of oxygen via nasal cannula, and febrile to 100.4F. Chest x-ray revealed peripheral and basilar patchy opacities concerning for COVID-19 ( Figure 1A Here, we discuss a case of suspected COVID-19 reinfection in the context of the growing body of Rolling updates on coronavirus disease (COVID-19) A Novel Coronavirus from Patients with Pneumonia in China Clinical Management of severe acute respiratory infection when COVID-19 is suspected: Interim guidance Recurrence of positive SARS-CoV-2 RNA in COVID-19: A case report South Korea reports more recovered coronavirus patients testing positive again Dynamic profile of RT-PCR findings from 301 COVID-19 patients in Wuhan, China: A descriptive study Positive RT-PCR Test Results in Patients Recovered From Persistence of Zika Virus in Body Fluids -Final Report Viral Load Kinetics of MERS Coronavirus Infection Factors Associated With Prolonged Viral Shedding in Patients With Avian Influenza A(H7N9) Virus Infection SARS-CoV-2 shedding and infectivity The Dynamic Relationship Between Clinical Symptomatology and Viral Shedding in Naturally Acquired Seasonal and Pandemic Influenza Virus Infections Clinical course and risk factors for mortality of adult inpatients with COVID-19 China: a retrospective cohort study Viral Shedding for 60 Days in a Woman with Novel Coronavirus Disease (COVID-19) Correlation of Chest CT. and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing Lack of Reinfection in Rhesus Macaques Infected with SARS-CoV-2