The patient started to show typical symptoms of COVID-19 on January 3, 2020 (disease course see Fig. 1). These symptoms include intermittent fever, occasional dry cough, general fatigue, malaise, poor appetite, and poor sleep. He took oral azithromycin by himself. He went to the fever clinic at Zhongnan Hospital of Wuhan University on January 7, 2020. He received intravenous infusion of amoxicillin/Clavulanate and his symptoms were improved. The chest CT images on January 8, 2020 showed infections in both lungs (viral pneumonia suspected) and he was admitted to the hospital. He received antivirals (oseltamivir, ganciclovir), antibiotics (yapenem, linezolid, moxifloxacin, ceftriaxone/tazobactam), and corticosteroids (methylprednisolone) treatment and low-flow oxygen in the hospital. Antibody test and nuclear acid test for common respiratory pathogens (adenovirus, parainfluenza virus, influenza virus type A and B, H7 avian influenza, Legionella, mycoplasma, and chlamydia) all were negative. Blood culture for aerobic and anerobic bacteria both came negative. After his symptoms were alleviated (no fever or cough) and lung infections got better as shown on chest CT images (January 9 and 14), he was discharged on January 15, 2020 with a diagnosis of COVID-19 (clinical diagnosis).
The patient was followed up at the outpatient clinic after discharge. RT-PCR tests for SARS-CoV-2 in the throat swabs were negative on January 28, positive on February 10 and 15, negative on February 17, 19, and 21 and March 4, positive on March 7, negative on March 11, 13, 14, and 24, positive on April 3, negative on April 8, and positive on April 14, 17, and 19, 2020. The results of IgM/IgG test for antibodies to SARS-CoV-2 (spike protein and nucleocapsid protein) were 1.37 AU/ml for IgM (negative) and 48.19 AU/ml for IgG (positive) on March 16, 2020 and 1.14 AU/ml for IgM (negative) and 49.65 AU/ml for IgG (positive) on April 3, 2020. His chest CT images showed continuous improvements in lung infections (Fig. 2).