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Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use

Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophe...

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Autores principales: Adedoyin, Oluwafeyi, Brijmohan, Sharmela, Lavine, Ross, Lisung, Fausto Gabriel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634224/
https://www.ncbi.nlm.nih.gov/pubmed/34844968
http://dx.doi.org/10.1136/bcr-2021-246308
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author Adedoyin, Oluwafeyi
Brijmohan, Sharmela
Lavine, Ross
Lisung, Fausto Gabriel
author_facet Adedoyin, Oluwafeyi
Brijmohan, Sharmela
Lavine, Ross
Lisung, Fausto Gabriel
author_sort Adedoyin, Oluwafeyi
collection PubMed
description Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients.
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spelling pubmed-86342242021-12-10 Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use Adedoyin, Oluwafeyi Brijmohan, Sharmela Lavine, Ross Lisung, Fausto Gabriel BMJ Case Rep Case Report Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients. BMJ Publishing Group 2021-11-29 /pmc/articles/PMC8634224/ /pubmed/34844968 http://dx.doi.org/10.1136/bcr-2021-246308 Text en © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ. https://bmj.com/coronavirus/usageThis article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
spellingShingle Case Report
Adedoyin, Oluwafeyi
Brijmohan, Sharmela
Lavine, Ross
Lisung, Fausto Gabriel
Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use
title Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use
title_full Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use
title_fullStr Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use
title_full_unstemmed Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use
title_short Undetectable SARS-CoV-2 active adaptive immunity—post-vaccination or post-COVID-19 severe disease—after immunosuppressants use
title_sort undetectable sars-cov-2 active adaptive immunity—post-vaccination or post-covid-19 severe disease—after immunosuppressants use
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634224/
https://www.ncbi.nlm.nih.gov/pubmed/34844968
http://dx.doi.org/10.1136/bcr-2021-246308
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