Background: SARS-CoV-2 infects respiratory tissues, and in some cases, replication-competent virus has been detected in extrapulmonary tissues, including brain (1). Viremic spread is suspected, and detection of viral RNA in blood is frequently reported (2). However, recovery of replication-competent virus from blood has not been previously demonstrated (3, 4).
Objective: To confirm viremia in a fatal COVID-19 case where viral sequence in blood and tissues match.
Case Report: A 76-year-old woman with a history of Turner syndrome, advanced dementia, and severe aortic stenosis was admitted to a community hospital in fall 2020 with new shortness of breath, hypoxia, and tachycardia per the patient’s home nursing facility. Her heart rate was 120 beats/min, respiratory rate was 30 breaths/min, and peripheral oxygen saturation was 84% on bilevel positive airway pressure. Chest radiograph revealed bilateral infiltrates, and a nasopharyngeal swab was positive for SARS-CoV-2 by reverse transcriptase polymerase chain reaction. She required invasive mechanical ventilation and was treated with dexamethasone, remdesivir, empirical antibiotics, and vasopressors, developing oliguric renal failure and lactic acidosis. Considering the patient’s critical illness and her end-of-life wishes, the family elected for comfort measures. She was compassionately extubated and died 1 day after admission.