The reinfection was confirmed by showing genetic differences in the viral genome between the two infections using next‐generation sequencing. There have been recent reports of reinfection with SARS‐CoV‐2. The other possibility is of reinfection with SARS CoV‐2. First, it could be a persistent carrier state and viral shedding with a possibility that the two negative reports in between were false negative. There could be three possibilities for the repeat‐positive SARS‐CoV‐2 in our patient and caregiver 2 months since the first infection. The patient and caregiver samples were not stored but tested on the same day of taking the swabs. The nasopharyngeal and oropharyngeal swabs were transported in a viral inactivation medium for RT‐PCR testing. The laboratories followed the guidelines issued by the Government of India for SARS‐CoV‐2 sample collection, transportation, testing, reporting, and quality control. The patient had not received steroids for 8 weeks before (augmented BFM consolidation phase) the first positive test and thereafter (interim maintenance phase).Īll the RT‐PCR tests on patient's and the caregiver's samples were performed by laboratories accredited by the Indian Council of Medical Research (ICMR). The patient and the caregiver continued to remain asymptomatic. This was 65 and 51 days after their first positive and first negative RT‐PCR test, respectively. However, both tested positive again for SARS‐Cov‐2 on Septemduring routine surveillance before admission for the fourth block of HDMTX. The patient and caregiver had tested negative for SARS‐CoV‐2 when they were admitted for the third block of HDMTX on August 12, 2020.

It is our policy to screen the patient and the caregiver for SARS‐Cov‐2 infection by RT‐PCR of their nasopharyngeal and oropharyngeal swabs before each block of chemotherapy or hospitalization. We did not test the patient or the caregiver for antibodies to SARS‐CoV‐2. His WBC count, ANC, and ALC at reinitiation of the ALL protocol were 5400, 1566, and 3200/mm 3, respectively. The patient resumed his cancer treatment (second cycle HDMTX with 6MP) on Jafter two negative RT‐PCR tests of nasopharyngeal and oropharyngeal swabs for SARS‐CoV‐2. The patient and the caregiver remained asymptomatic during their hospitalization for SARS‐CoV‐2 infection. The patient's WBC count, ANC, and ALC were 12 900, 5547, and 6597/mm 3, respectively, on day 5 of SARS‐CoV‐2 positivity. Both tested positive for SARS‐CoV‐2 on RT‐PCR of their nasopharyngeal and oropharyngeal swabs on repeat testing on days 5 and 10, and tested negative on days 14 and 21. The patient and the caregiver were quarantined in a COVID19‐designated hospital. 6MP was stopped after the patient tested positive. His white blood cell (WBC) count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) were 2500, 650, and 1225/mm 3, respectively, on the day of the positive RT‐PCR test. The patient had started the interim maintenance phase of the protocol and was 5 days post the first 24‐h high‐dose methotrexate (HDMTX) infusion (3 gm/m 2) along with 6‐mercaptopurine (6MP) when he tested positive for SARS‐CoV‐2. On June 27, 2020, the patient and his caregiver tested positive for SARS‐CoV‐2 on the reverse transcriptase‐polymerase chain reaction (RT‐PCR) test of their nasopharyngeal and oropharyngeal swabs.They were asymptomatic but were tested as they were high‐risk contacts of a COVID19 patient. The patient was receiving treatment with the Indian Childhood Collaborative Leukaemia Group (ICiCLe) protocol under the high‐risk arm. A 4‐year‐old male was treated for pre‐B cell acute lymphoblastic leukemia (ALL) at our hospital. The SARS‐CoV‐2 virus is responsible for the ongoing coronavirus disease 2019 (COVID19) pandemic. We report a case of repeat positivity with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a child with cancer.

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