Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised Patient

• Published in: The Journal of infectious diseases Vol. 223; no. 1; pp. 23 - 27
• Main Authors: Baang, Ji Hoon, Smith, Christopher, Mirabelli, Carmen, Valesano, Andrew L, Manthei, David M, Bachman, Michael A, Wobus, Christiane E, Adams, Michael, Washer, Laraine, Martin, Emily T, Lauring, Adam S
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 04-01-2021
• Subjects: Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - therapeutic use; Alanine - analogs & derivatives; Alanine - therapeutic use; Antibodies, Viral - blood; Antiviral drugs; Brief Report; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - virology; Disease transmission; Hospitalization; Humans; Humoral immunity; Immunity, Humoral; Immunocompromised Host; Immunocompromised hosts; Immunodeficiency; Lymphocytes B; Lymphoma; Lymphoma, Mantle-Cell - complications; Male; Middle Aged; Primary Immunodeficiency Diseases - complications; Replication; SARS-CoV-2 - physiology; Sequence analysis; Seroconversion; Severe acute respiratory syndrome coronavirus 2; Virus Replication; COVID-19; SARS-CoV-2; immunocompromise; antibody; evolution
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiaa666

Abstract
We describe a case of chronic coronavirus disease 2019 (COVID-19) in a patient with lymphoma and associated B-cell immunodeficiency. Viral cultures and sequence analysis demonstrate ongoing replication of infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for at least 119 days. The patient had 3 admissions related to COVID-19 over a 4-month period and was treated twice with remdesivir and convalescent plasma with resolution of symptoms. The patient’s lack of seroconversion and prolonged course illustrate the importance of humoral immunity in resolving SARS-CoV-2 infection. This case highlights challenges in managing immunocompromised hosts, who may act as persistent shedders and sources of transmission.
A detailed study of chronic COVID-19 in a patient with hematologic malignancy. The patient shed infectious virus for >119 days. This case highlights unique challenges in infection control and the clinical management of immunocompromised hosts.