Abstract
Background: Even though RT-PCR tests are generally considered the gold standard for diagnosing SARS-CoV-2, they are not without flaws, and the likelihood of detecting an infection varies depending on when the test is performed. There is chance of false negative due to different pitfalls. So there is essential of correlation of radiological characteristics, abnormalities in biochemical tests and symptoms of suspected patient during COVID-19 epidemic.
 Case presentation: Herein, we report a 42-year-old male patient with high-grade fever, dry cough, headache and dizziness. He went for the RT-PCR test two times and reported negative. On the chest X-Ray, there was opacity on both lungs and referred to cancer-hospital for lung-cancer screening. The patient underwent chest-HRCT and laboratory tests for further evaluation and was identified as typical COVID-19 findings. Then the patient was isolated and treatment of given according to COVID-19 treatment guidelines 
 Conclusion: It is concluded that a clinically symptomatic patient with typical chest HRCT and abnormal lab findings for COVID-19 should be considered as a COVID-19 patient and isolated even with two negative RT-PCR tests.
Highlights
Background Even though RTPCR tests are generally considered the gold standard for diagnosing SARS-CoV-2, they are not without flaws, and the likelihood of detecting an infection varies depending on when the test is performed
The indications of COVID-19 can be non-specific, so investigative confirmation in the hospital is often needed after detecting SARS-CoV-2 RNA sequences by reverse transcription (RT-PCR) of a clinical sample
According to history taken from the patient and his reports, we reported a 42-year-old male patient from rural Myagdi district of Nepal presenting with high-grade fever, dry cough, headache, and dizziness on August 10, 2021, during the second phase of the second phase COVID-19 pandemic
Summary
COVID-19 is an infectious disease first identified in Wuhan, China. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 virus-infected patients must go for nasopharyngeal or oropharyngeal RT-PCR double-swab test and Chest radiography for the first step and the further detail evaluation. HRCT chest and biochemical laboratory tests are recommended in case of inconsistency between characteristics of clinical history and radiological findings [1]. The patient had no history of diabetes and hypertension in the past He underwent an RT-PCR test at his home district’s local COVID-19 screening centre and was reported as negative in the RT-PCR test. After that, he was referred to Lumbini Zonal hospital for further evaluation and treatment. At BP Koirala Memorial Cancer Hospital, the patient underwent HRCT chest and biochemical laboratory tests for further evaluation.
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