Successful recovery of recurrence of positive SARS-CoV-2 RNA in COVID-19 patient with systemic lupus erythematosus: a case report and review

Abstract

COVID-19 has become a global concern. A large number of reports have explained the clinical characteristics and treatment strategies of COVID-19, but the characteristics and treatment of COVID-19 patient with systemic lupus erythematosus (SLE) are still unclear. Here, we report the clinical features and treatment of the first SLE patient with confirmed COVID-19 pneumonia. This was a 39-year-old woman, diagnosed with SLE 15 years ago, whose overall clinical characteristics (symptoms, laboratory tests, and chest CTs) were similar to those of the general COVID-19 patients. She continued to take the previous SLE drugs (doses of glucocorticoids, hydroxychloroquine, and immunosuppressive agents were not reduced) and was treated with strict antiviral and infection prevention treatment. After the first discharge, she got a recurrence of COVID-19 during her home isolation, and then returned to hospital and continued the previous therapy. Finally, this long-term immune suppressive patient's COVID-19 was successfully cured. The successful recovery of this case has significant reference value for the future treatment of COVID-19 patients with SLE. Key Points • COVID-19 patients with SLE is advocated to continue the medical treatment for SLE. • Hydroxychloroquine may have potential benefits for COVID-19 patients with SLE. • COVID-19 patients with SLE is prone to relapse, and multiple follow-ups are necessary.

Keywords: COVID-19; Recurrence; SARS-CoV-2; Systemic lupus erythematosus.

Fig. 1

Timeline of disease course according to days from initial presentation of illness and days from hospital admission. + means SARS-CoV-2 RNA is positive. − means SARS-CoV-2 RNA is negative. x means chest CT is done on that day

Fig. 2

High-resolution computed tomography images of twice hospital admission and twice follow-ups. a CTs after the first hospital admission, multiple ground glass density lesions were observed in the lower lobe of the bilateral lung. b CTs after the recurrence of positive SARS-CoV-2 RNA. c CTs during follow-up. The red arrows indicate the lesions