Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2022
Prolonged SARS-CoV-2 infection associated with long-term corticosteroid use in a patient with impaired B-cell immunity.
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Morishita Momoko, Suzuki Manabu, Matsunaga Akihiro, Ishizhima Keishi, Yamamoto Tsukasa, Kuroda Yudai, Kanno Takayuki, Tsujimoto Yoshie, Ishida Akane, Hashimoto Masao, Ishii Satoru, Takasaki Jin, Naka Go, Iikura Motoyasu, Izumi Shinyu, Suzuki Tadaki, Maeda Ken, Ishizaka Yukihito, Hojo Masayuki, Sugiyama Haruhito
Аннотация
Corticosteroids are widely used to treat severe COVID-19, but in immunocompromised individuals, who are susceptible to persistent infection, long term corticosteroid use may delay viral clearance. We present a case of prolonged SARS-CoV-2 infection in a man with significantly impaired B-cell immunity due to non-Hodgkin lymphoma which had been treated with rituximab. SARS-CoV-2 shedding persisted, despite treatment with remdesivir. Viral sequencing confirmed the persistence of the same viral strain, ruling out the possibility of reinfection. Although SARS-CoV-2 IgG, IgA and IgM remained negative throughout the treatment period, after reduction of the corticosteroid dose, PCR became negative. Long-term corticosteroid treatment, especially in immunocompromised individuals, may result in suppression of cell-mediated immunity and prolonged SARS-CoV-2 infection.