# Caution to psychiatry ward: COVID‐19 pneumonia can manifest weeks or months after testing positive with a PCR test in individuals on preexisting immune‐suppressing medication

## TL;DR

A patient on immune-suppressing medication developed severe depression and later pneumonia weeks after a positive COVID-19 test, highlighting risks in psychiatric wards.

## Contribution

First report of delayed COVID-19 pneumonia in a psychiatric ward for a patient on immunosuppressive drugs.

## Key findings

- A patient on immunosuppressive drugs developed pneumonia 3 weeks after a positive PCR test.
- The patient required hospitalization and treatment with remdesivir, but pneumonia recurred later.
- This case highlights the need for infection control in psychiatric wards for immunocompromised patients.

## Abstract

Some patients are reported to develop depression immediately after COVID‐19 infection. Typically, hospitalization is arranged a week to 10 days after symptom onset to avoid outbreak in the psychiatric ward when infectivity is almost eliminated. However, in patients on immunosuppressive drugs, infection is known to persist beyond the 10th day after testing positive with a polymerase chain reaction (PCR) test.

We present a patient with follicular lymphoma who was receiving immune‐suppressing medication and contracted a COVID‐19 infection; she developed severe depression and eventually required hospitalization 10 days after symptom onset or 5 days after the COVID‐19 infection‐related symptoms disappeared. Although the patient did not exhibit any symptom of pneumonia upon admission, she developed COVID‐19 pneumonia 3 weeks after the initial positive test. She received intravenous infusion of the antiviral drug remdesivir, which led to the improvement of pneumonia, and she was discharged on day 32 from testing COVID‐19 positive. However, COVID‐19 pneumonia recurred on days 64 and 74.

This is the first report of COVID‐19 pneumonia developing in a psychiatric ward in a patient on immunosuppressive drugs, weeks to months after testing positive with a PCR test. When patients with compromised immune function, such as those on immunosuppressant medication or those with human immunodeficiency virus disease, are admitted to a psychiatric ward, careful monitoring of the risk of recurrence and sufficient consideration for infection control measures are necessary to avoid outbreaks.