1. Prolonged SARS-CoV-2 infection following rituximab treatment: clinical course and response to therapeutic interventions correlated with quantitative viral cultures and cycle threshold values.
- Author
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Thornton CS, Huntley K, Berenger BM, Bristow M, Evans DH, Fonseca K, Franko A, Gillrie MR, Lin YC, Povitz M, Shafey M, Conly JM, and Tremblay A
- Subjects
- COVID-19 prevention & control, COVID-19 Vaccines administration & dosage, Humans, Immunocompromised Host, Male, Middle Aged, Nasopharynx, Tomography, X-Ray Computed, Treatment Outcome, Viral Load, COVID-19 Drug Treatment, COVID-19 pathology, Rituximab pharmacology, SARS-CoV-2 drug effects, Virus Shedding drug effects
- Abstract
Background: Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is completed through reverse transcriptase-PCR (RT-PCR) from either oropharyngeal or nasopharyngeal swabs, critically important for diagnostics but also from an infection control lens. Recent studies have suggested that COVID-19 patients can demonstrate prolonged viral shedding with immunosuppression as a key risk factor., Case Presentation: We present a case of an immunocompromised patient with SARS-CoV-2 infection demonstrating prolonged infectious viral shedding for 189 days with virus cultivability and clinical relapse with an identical strain based on whole genome sequencing, requiring a multi-modal therapeutic approach. We correlated clinical parameters, PCR cycle thresholds and viral culture until eventual resolution., Conclusions: We successfully demonstrate resolution of viral shedding, administration of COVID-19 vaccination and maintenance of viral clearance. This case highlights implications in the immunosuppressed patient towards infection prevention and control that should consider those with prolonged viral shedding and may require ancillary testing to fully elucidate viral activity. Furthermore, this case raises several stimulating questions around complex COVID-19 patients around the role of steroids, effect of antiviral therapies in absence of B-cells, role for vaccination and the requirement of a multi-modal approach to eventually have successful clearance of the virus., (© 2022. The Author(s).)
- Published
- 2022
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