COVID-19 with positive bronchoalveolar lavage fluid but negative nasopharyngeal and oropharyngeal swabs: A case report and insights

Abstract

Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, with some patients rapidly progressing to acute respiratory distress syndrome (ARDS). Nasopharyngeal and oropharyngeal swab specimens tested by real-time reverse transcription-polymerase chain reaction (RT-PCR) are the most commonly used methods to diagnose COVID-19. Herein, we investigate and discuss a 33-year-old case of COVID-19, without any preexisting medical conditions, whose both nasopharyngeal and oropharyngeal swabs were negative in the prodromal phase despite showing COVID-19 symptoms. However, after 3 days, with severe dyspnea and rapidly progressed ARDS, the patient was identified as infected by COVID-19 by testing bronchoalveolar lavage fluid (BALF). He was intubated in the intensive care unit (ICU) but expired on the 4th day. This case shows the importance of active and accurate monitoring of the patients showing COVID-19 symptoms. If nasopharyngeal and oropharyngeal swabs are negative, a BALF test is recommended if performed by an expert operator.