COVID-19 pandemic has become a worldwide public health crisis since December 2019. Recurrence of COVID-19 has been well documented in many researches, but the nature of the recurrence is still debated. Although severe disease typically occurs in older individuals with comorbidities. This case report describes an uncommon presentation of a patient with COVID-19 recurrence. 

A 69-year-old male who was discharged to a skilled nursing facility following hospitalization for complications with a lumbar hardware infection.

He had a history of multiple thoracolumbar fusions with recurrent Pseudomonas spine infection, spastic paraplegia with neurogenic bladder and bowel, prostate cancer status post radiation therapy, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Over the subsequent days, a COVID-19 outbreak occurred in the concerned skilled nursing facility. The patient developed an initial fever of 101.4°F (38.6°C) and was confirmed positive for COVID-19 on the 5th day.

Throughout his disease course, he developed a maximal fever of 102.2°F (39.0°C) on the 2nd day and did not have any subsequent fevers. Pulse oximetry showed maximum variations between 1st and, and 7th day, with a low of 92% on the 6th day. However, it stabilized after the 8th day. 

Comprehensive metabolic panels remained mostly unremarkable except for 2 days of mild lymphopenia (600/mm3, 800/mm3) and 1 day of mild neutrophilia (8,200/mm3). The patient stayed otherwise asymptomatic.

He tested negative for COVID-19 using RT-PCR on the 25th day. He was later discharged home from the skilled nursing facility after 13 more days. His repeated COVID-19 report remained negative and he remained out in the community afterwards.

He experienced an episode of syncope during an outpatient appointment after >2 months of his COVID illness and was transported to the emergency department for hospital admission, where he was again tested positive for COVID-19.

The patient did not develop a fever until 2 days after his episode of syncope. His maximal temperature was 101.3°F (38.5°C) on the 3rd day but had no fevers on subsequent days. Pulse oximetry ranged from 96% to 100% throughout his hospital stay of 8 days. Chest x-ray showed no acute changes. Extensive cardiac and infectious workup was negative, and etiology for the patients syncope was specified to be unrelated to COVID-19 and likely vasovagal. He was eventually discharged from the hospital after 8days.

Leung S, Hossain N. Recurrence and Recovery of COVID-19 in an Older Adult Patient with Multiple Comorbidities: A Case Report. Gerontology. 2021;67(4):445-448. doi: 10.1159/000514675. Epub 2021 Mar 19. PMID: 33744883; PMCID: PMC8089439.