COVID-19 in a patient with long-term use of glucocorticoids: A study of a familial cluster

• Published in: Clinical immunology (Orlando, Fla.) Vol. 214; p. 108413
• Main Authors: Han, Yuanyuan, Jiang, Mao, Xia, Da, He, Lichao, Lv, Xin, Liao, Xiaohua, Meng, Jie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2020
• Subjects: Adult; Aged, 80 and over; Atypical infection; Betacoronavirus; China; Coronavirus Infections - drug therapy; COVID-19; Familial cluster; Female; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Immunocompromised; Incubation period; Infectious Disease Incubation Period; Lung - diagnostic imaging; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Male; Middle Aged; Pandemics; Pneumonia, Viral - drug therapy; SARS-CoV-2; Shedding duration; Virus Shedding; China; COVID-19; SARS-CoV2; Incubation period; Atypical infection; Shedding duration; ESR; Immunocompromised; WBC; Familial cluster; SLE
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1016/j.clim.2020.108413

Clusters of patients with novel coronavirus disease 2019 (COVID-19) have been successively reported globally. Studies show clear person-to-person transmission. The average incubation period is 2–14 days, and mostly 3–7 days. However, in some patients, this period may be longer. Here, we report a familial cluster of COVID-19 where a 47-year-old woman with long-term use of glucocorticoids did not develop any symptoms within the 14-day quarantine period but was confirmed with COVID-19 by tested positive of antibody on day 40 after she left Wuhan. Almost at the same time, her father and sister were diagnosed with COVID-19. The results suggest that the long-term use of glucocorticoids might cause atypical infections, a long incubation period, and extra transmission of COVID-19. •We report a familial cluster of COVID-19 outside of Wuhan, including 3 confirmed cases out of 5 family members.•The index patient, who had been taking glucocorticoids for 16 years, initially developed atypical symptoms of COVID-19.•The incubation period and shedding time were extremely long in this familial case.•Our results suggest a longer quarantine time for patients with long-term glucocorticoid use.