Prolonged SARS-CoV-2 Infection and Organizing Pneumonia in a Patient with Follicular Lymphoma, Treated with Obinutuzumab—Challenging Recognition and Treatment

Łyżwa, E.; Sobiecka, Małgorzata; Lewandowska, Katarzyna; Siemion-Szcześniak, Izabela; Barańska, I.; Klatt, M.; Langfort, R.; Szturmowicz, Monika; Tomkowski, Witold

doi:10.3390/v15030693

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…IVIG in combination with antiviral therapy has been successful in the clearance of virus when directed monoclonal antibodies have failed. This is an important consideration when variant assignments are unavailable 57 …”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, treatment of immunocompromised patients with convalescent plasma has been shown to select 'escape mutants' , which demonstrate reduced sensitivity to convalescent plasma. 56 IVIG is another product available to boost neutralizing antibody titers in patients with prolonged positivity. IVIG in combination with antiviral therapy has been successful in the clearance of virus when directed monoclonal antibodies have failed.…”

Section: Multi-modal Therapy With An Antiviral In Combination With Ne...mentioning

confidence: 99%

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Antiviral therapies for the management of persistent coronavirus disease 2019 in immunocompromised hosts: A narrative review

Kinsella,

Moso,

Morrissey

et al. 2024

Transplant Infectious Dis

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Antiviral agents with activity against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have played a critical role in disease management; however, little is known regarding the efficacy of these medications in the treatment of SARS‐CoV‐2 infection in immunocompromised patients, particularly in the management of persistent SARS‐CoV‐2 positivity.This narrative review discusses the management of persistent coronavirus disease 2019 in immunocompromised hosts, with a focus on antiviral therapies. We identified 84 cases from the literature describing a variety of approaches, including prolonged antiviral therapy (n = 11), combination antivirals (n = 13), and mixed therapy with antiviral and antibody treatments (n = 60). A high proportion had an underlying haematologic malignancy (n = 67, 80%), and were in receipt of anti‐CD20 agents (n = 51, 60%). Success was reported in 70 cases (83%) which varied according to the therapy type. Combination therapies with antivirals may be an effective approach for individuals with persistent SARS‐CoV‐2 positivity, particularly those that incorporate treatments aimed at increasing neutralizing antibody levels. Any novel approaches taken to this difficult management dilemma should be mindful of the emergence of antiviral resistance.

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Section: Resultsmentioning

confidence: 99%

Section: Multi-modal Therapy With An Antiviral In Combination With Ne...mentioning

confidence: 99%

Antiviral therapies for the management of persistent coronavirus disease 2019 in immunocompromised hosts: A narrative review

Kinsella,

Moso,

Morrissey

et al. 2024

Transplant Infectious Dis

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“…Despite the pathological diagnosis of organizing pneumonia, two patients were identified as having COVID-19 pneumonia and received antiviral therapy along with steroids, eventually showing improvement. Conversely, one patient was regarded as having obinutuzumab-induced organizing pneumonia and only treated with methylprednisolone [ 24 ]. It was only after revising the diagnosis to pneumonia due to prolonged SARS-CoV-2 infection and initiating remdesivir treatment that the patient improved.…”

Section: Further Discussionmentioning

confidence: 99%

“…Additional methodological details are provided in Figure 1 and in the Supplementary Methods and Supplementary Tables 1, 2 . This review included 19 studies that reported on a total of 24 patients (median age, 54.5 years [interquartile range (IQR) 44–64 years]; 15 male) [ 7 8 9 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ].…”

Section: Systematic Search and Analysis Of Literaturementioning

confidence: 99%

Radiologic Abnormalities in Prolonged SARS-CoV-2 Infection: A Systematic Review

Beck,

Yoon,

Yoon

2024

Korean J Radiol

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We systematically reviewed radiological abnormalities in patients with prolonged SARS-CoV-2 infection, defined as persistently positive polymerase chain reaction (PCR) results for SARS-CoV-2 for > 21 days, with either persistent or relapsed symptoms. We extracted data from 24 patients (median age, 54.5 [interquartile range, 44–64 years]) reported in the literature and analyzed their representative CT images based on the timing of the CT scan relative to the initial PCR positivity. Our analysis focused on the patterns and distribution of CT findings, severity scores of lung involvement on a scale of 0–4, and the presence of migration. All patients were immunocompromised, including 62.5% (15/24) with underlying lymphoma and 83.3% (20/24) who had received anti-CD20 therapy within one year. Median duration of infection was 90 days. Most patients exhibited typical CT appearance of coronavirus disease 19 (COVID-19), including ground-glass opacities with or without consolidation, throughout the follow-up period. Notably, CT severity scores were significantly lower during ≤ 21 days than during > 21 days ( P < 0.001). Migration was observed on CT in 22.7% (5/22) of patients at ≤ 21 days and in 68.2% (15/22) to 87.5% (14/16) of patients at > 21 days, with rare instances of parenchymal bands in previously affected areas. Prolonged SARS-CoV-2 infection usually presents as migrating typical COVID-19 pneumonia in immunocompromised patients, especially those with impaired B-cell immunity.

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Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era

Götz,

Mathé,

Agarwal

et al. 2023

Infection

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Purpose This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication. Methods We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included. Results 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17). Conclusion Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days. Trial registration number DRKS 00027299.

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Prolonged SARS-CoV-2 Infection and Organizing Pneumonia in a Patient with Follicular Lymphoma, Treated with Obinutuzumab—Challenging Recognition and Treatment

Cited by 9 publications

References 20 publications

Antiviral therapies for the management of persistent coronavirus disease 2019 in immunocompromised hosts: A narrative review

Antiviral therapies for the management of persistent coronavirus disease 2019 in immunocompromised hosts: A narrative review

Radiologic Abnormalities in Prolonged SARS-CoV-2 Infection: A Systematic Review

Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era

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