More evidence suggesting the lack of negative predictive value of the nasopharyngeal swab RT-PCR continues to build:
A case report of an obese 14 year old boy who presented initially with fever, gastrointestinal symptoms, and a negative COVID-19 nasopharyngeal swab subsequently developed severe respiratory and cardiac symptoms and positive SARS-CoV-2 on retest. This case emphasizes obesity as a potential independent risk factor for COVID-19 as well as the poor negative predictive value of nasopharyngeal swabs.
A case report of a cystic fibrosis patient with ultimately diagnosed with COVID-19 via positive RT-PCR after 2 false negatives and a subsequent positive rhinovirus test highlights that identifying another respiratory pathogen should not exclude the possibility of an additional infection of SARS-CoV-2 in patients with severe respiratory disease and the propensity for false negative SARS-CoV-2 RT-PCR result.
Clinicians are urged to differentiate between High Altitude Pulmonary Edema (HAPE) and COVID-19 because pulmonary vasodilators routinely used to treat HAPE could critically worsen ventilation-perfusion mismatch or cause hypotension in COVID-19 patients.
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