SARS-CoV-2-Related Persistent Pulmonary Affection Case in A 55-Year-Old Gastric MALT Lymphoma Patient on Rituximab

Abstract

Following a mild symptomatic SARS-CoV-2 infection, a 55-year-old patient with gastric MALT lymphoma, currently treated with rituximab, experienced persistent symptoms. Over subsequent months, the patient exhibited low-grade fever, dyspnea, and progressive desaturation, leading to respiratory failure necessitating home oxygen therapy. A PCR test confirmed SARS-CoV-2 infection, prompting suspicion of persistent COVID-19. Imaging and biopsy results were consistent with cryptogenic organizing pneumonia (COP), but the patient showed no response to treatment, including corticosteroids and immunosuppressants. Remdesivir treatment yielded partial improvement but failed to achieve full resolution. Plitidepsin (2.5 mg/day for 3 days) under compassionate use led to negative PCR tests and normal respiratory function restoration within 3 days after treatment. SARS-CoV-2's impact on immunocompromised patients is concerning due to unique clinical features, challenges in viral clearance and immunization, and varied responses to approved treatments. A phase II clinical trial is underway to assess plitidepsin's efficacy in immunocompromised COVID-19 adults requiring hospital care.