Abstract
Background
Management of immunocompromised COVID-19 patients is the object of current debate. Accumulating evidence suggest that treatment with high-titer COVID-19 convalescent plasma (CCP) may be effective in this characteristic clinical scenario.
Case report
A 52-years old immunocompromised female patient, previously treated with rituximab for low grade B-cell lymphoma, showed prolonged SARS-CoV-2 shedding and a long-term course of signs of severe COVID-19. A first cycle of treatment with remdesivir, a nucleotide analogue prodrug effective in inhibiting SARS-CoV-2 replication, did not provide fully and sustained clinical remission. A second hospitalization was deemed necessary after 10 days from the first hospital discharge due to recrudescence of symptoms of severe COVID-19 and the evidence of bilateral interstitial pneumonia at the chest-CT scan. Clinical and radiological findings completely disappeared after CCP administration. The viral culture confirmed the absence of SARS-CoV-2-related cytopathic effect. The clinical evaluation, performed two months after hospital discharge, was unremarkable.
Results
Findings from our case report suggest that the host T-cell specific response to SARS-CoV-2 is not sufficient to reduce viral load in the absence of neutralizing antibodies. Acquired immune antibodies and/or related components passively infused with CCP might help in boosting the plasma recipient response to the virus and promoting complete viral clearance.
Conclusions
Independently from negative results in immunocompetent individuals, the potential effectiveness of CCP infusion in selected cohorts of patients with primary or secondary impaired immune response should be tested. Further research about mechanisms of host response in immunocompromised patients with SARS-CoV-2 infection is required.
【저자키워드】 COVID-19, convalescent plasma, Remdesivir, rituximab, Hypogammaglobulinemia, immune deficiency, 【초록키워드】 Treatment, SARS-CoV-2, immune response, severe COVID-19, Hospitalization, Neutralizing antibodies, antibody, SARS-COV-2 infection, Symptom, host response, virus, viral clearance, immune, Case report, Immunocompromised patient, Viral load, B-cell lymphoma, clinical evaluation, clinical, female, Research, Patient, Effectiveness, Immunocompromised, plasma, interstitial pneumonia, viral culture, characteristic, SARS-CoV-2 replication, mechanism, Evidence, Cytopathic effect, nucleotide, COVID-19 patient, CCP, hospital discharge, help, CCP administration, finding, component, Host, Complete, effective, radiological finding, Course, Result, selected, tested, performed, required, treated, absence, reduce, individuals, inhibiting, sustained, Acquired, cohorts of patient, infused, T-cell specific, 【제목키워드】 Case report, Immunocompromised patient, Convalescent plasma therapy,