Abstract
Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients.
Keywords: COVID-19; immunological products and vaccines; infections; infectious diseases; malignant disease and immunosuppression.
【저자키워드】 COVID-19, Infectious diseases, infections, immunological products and vaccines, malignant disease and immunosuppression, 【초록키워드】 Dexamethasone, convalescent plasma, antibodies, IgG, Respiratory distress syndrome, ARDS, COVID-19 pneumonia, Infectious diseases, Respiratory failure, adaptive, acute respiratory distress syndrome, Immunity, multiple sclerosis, Pneumonia, Infection, Immunosuppression, Remdesivir, immunosuppressants, rituximab, COVID-19 vaccination, nucleocapsid, Patient, convalescent, dissemination, information, Admission, Care, patients, SARS-CoV-2 IgM, immunosuppressed patients, Ocrelizumab, tacrolimus, acute respiratory distress, readmission, Immunosuppressed, mycophenolate, respiratory distress, secondary to, one patient, two patients, worsening, syndrome, renal, malignant disease, Standard-of-care, helping, immunological, highlight, IMPROVE, tested, died, reported, required, treated, New, immunosuppressed patient, ulcerative, undetectable, with COVID-19, 【제목키워드】 SARS-CoV-2, adaptive, Immunosuppressant,