Efficacy of convalescent plasma therapy in immunocompromised patients with COVID-19: A case report.
COVID-19
Convalescent plasma
Hypogammaglobulinemia
Immune deficiency
Remdesivir
Rituximab
Journal
Clinical infection in practice
ISSN: 2590-1702
Titre abrégé: Clin Infect Pract
Pays: England
ID NLM: 101757436
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
15
05
2021
revised:
25
08
2021
accepted:
26
08
2021
entrez:
7
9
2021
pubmed:
8
9
2021
medline:
8
9
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
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
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.
Identifiants
pubmed: 34490417
doi: 10.1016/j.clinpr.2021.100096
pii: S2590-1702(21)00033-9
pmc: PMC8408049
doi:
Types de publication
Case Reports
Langues
eng
Pagination
100096Informations de copyright
© 2021 The Author(s).
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
N Engl J Med. 2021 Nov 18;385(21):1951-1960
pubmed: 34407339
J Extracell Vesicles. 2020 Oct;10(1):e12004
pubmed: 33304473
J Infect Dis. 2021 May 20;223(9):1522-1527
pubmed: 33556961
Blood. 2020 Nov 12;136(20):2290-2295
pubmed: 32959052
Enferm Infecc Microbiol Clin (Engl Ed). 2021 Feb 11;:
pubmed: 33741148
N Engl J Med. 2020 Dec 3;383(23):2291-2293
pubmed: 33176080
Lancet. 2021 May 29;397(10289):2049-2059
pubmed: 34000257
Lancet Microbe. 2021 Apr;2(4):e138
pubmed: 33817676
Clin Lymphoma Myeloma Leuk. 2020 Nov;20(11):774-776
pubmed: 32933879