Case Report: Discovery a Novel SARS-CoV-2 Variant in a Six-Months Long-Term Swab Positive Female Suffering From Non-Hodgkin Lymphoma

Abstract

BackgroundWe report the case of a woman with non-Hodgkin lymphoma who remained positive on the molecular assay for SARS-CoV-2 for six months: she has never experienced a severe form of COVID-19 although in absence of seroconversion.MethodsThe whole SARS-CoV-2 genome analysis was performed by the CleanPlex SARS-CoV-2 Research and Surveillance NGS Panel (PARAGON GENOMICS, Hayward, USA).ResultsWe found twenty-two mutations in SARS-CoV-2 genome and a novel deleterious ORF3a frameshift c.766_769del corresponding to a unique and novel lineage. The region affected by this frameshift variant is reported as being important in determining SARS-CoV-2 immunogenicity. Patient’s immunophenotype showed the absence of B lymphocytes and significantly reduced T-cell count. Only after the treatment with hyperimmune plasma she finally became negative on the swab.ConclusionsOur findings could be helpful in the management of patients with immunodeficiency, particularly when novel variants, potentially altering the virus immune response, are present.

Global reported impacts of COVID‐19 on lymphoma patients and the emerging clinical management approaches in response to the ongoing pandemic

“…29 Patients with hematological malignancies such as lymphoma appear to have a greater risk of contracting SARS-CoV-2 infection, as well as experiencing more severe and prolonged infection. 30 Due to the nature of lymphoma, or B-cell targeting treatments, lymphopenia or immunosuppression, are often seen. A study by Yasuda et al, found that patients who underwent recent rituximab therapy were less likely to develop anti-SARS-CoV-2 antibodies thereby, becoming more likely to experience severe and prolonged COVID-19 infections, as well as bacterial or fungal pneumonia.…”

“…Patients with hematological malignancies such as lymphoma appear to have a greater risk of contracting SARS‐CoV‐2 infection, as well as experiencing more severe and prolonged infection 30 . Due to the nature of lymphoma, or B‐cell targeting treatments, lymphopenia or immunosuppression, are often seen.…”

Immunocompromised Patients with Protracted COVID-19: a Review of “Long Persisters”

“…As described in the "Direct Acting Antivirals" section, Brown et al suggested that combination of RDV and passive humoral therapy is superior to RDV alone for clearing protracted infections [41•]; however, Hueso et al used CCP alone with success [46•]. Smaller case series and case reports have shown clinical improvement and/or viral clearance [48][49][50][51][52][53], while others have failed to show effectiveness [2,6].…”