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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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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. |
format | Online Article Text |
id | pubmed-8634224 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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