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KEITH BRADSHER
NEW YORK TIMES

HONG KONG�Local health officials said here last night that 12 patients who had seemed to recover from SARS became ill again after leaving the hospital.

In some cases, the illness returned more than two weeks after discharge, according to a medical expert here who refused to be quoted by name. It is not clear whether the patients contracted the infection a second time, or simply became ill with the same virus after seeming to recover.

Six of the patients are still hospitalized, their condition described as "stable and good" by the Hong Kong Hospital Authority. The rest have been discharged for the second time.

But the relapses, the first reported since the epidemic broke out in China last fall, raise unsettling questions about the disease, about which much is still unknown.

The relapses may mean that patients can still transmit severe acute respiratory syndrome, or SARS, even when they are thought to be no longer infectious.

If so, that raises the possibility that transmission might recur in countries where officials have said the outbreak is over.

Less ominously, the relapses could be a complication of treatment, perhaps from the use of steroids that so suppressed the patients' immune system that they did not have a chance to develop a strong enough immune defence against SARS.

Hong Kong officials said nothing about these possibilities last night.

The World Health Organization said yesterday that it had not yet received reports of the relapses.

Dr. Mark Salter, a medical officer with the agency, said it was monitoring the nearly 2,500 SARS patients worldwide who have been discharged from hospitals and had seen no reports of relapses or recurrences.

If relapses are occurring, Salter said, "we would be concerned.''

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention in Atlanta, said in an interview yesterday she was aware of the reported relapses but had no details and could not interpret the phenomenon.

In an ideal world, Gerberding said, scientists would try to find out whether the virus that causes SARS was confirmed in the 12 patients when they were first hospitalized and whether it could still be identified after their relapses, or whether the patients had developed one of the many respiratory ailments other than SARS.

The new development is another sign of the critical need for doctors to develop a diagnostic test for SARS.

Many SARS patients in Hong Kong are prescribed continuing doses of steroids after they are discharged from the hospital.

Doctors here are increasingly concerned that heavy doses of steroids may be suppressing the symptoms of the disease without getting rid of the virus.