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Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment

Background: Persistent fever after SARS-CoV-2 infection in rituximab-treated patients has been reported. Due to reduced sensitivity in conventional sampling methods and unspecific symptoms in these patients, distinguishing between low-grade viral replication or hyperinflammation is challenging. Anti...

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Autores principales: Ertesvåg, Nina Urke, Sakkestad, Sunniva Todnem, Zhou, Fan, Hoff, Ingrid, Kristiansen, Trygve, Jonassen, Trygve Müller, Follesø, Elisabeth, Brokstad, Karl Albert, Dyrhovden, Ruben, Mohn, Kristin G.-I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9414720/
https://www.ncbi.nlm.nih.gov/pubmed/36016378
http://dx.doi.org/10.3390/v14081757
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author Ertesvåg, Nina Urke
Sakkestad, Sunniva Todnem
Zhou, Fan
Hoff, Ingrid
Kristiansen, Trygve
Jonassen, Trygve Müller
Follesø, Elisabeth
Brokstad, Karl Albert
Dyrhovden, Ruben
Mohn, Kristin G.-I.
author_facet Ertesvåg, Nina Urke
Sakkestad, Sunniva Todnem
Zhou, Fan
Hoff, Ingrid
Kristiansen, Trygve
Jonassen, Trygve Müller
Follesø, Elisabeth
Brokstad, Karl Albert
Dyrhovden, Ruben
Mohn, Kristin G.-I.
author_sort Ertesvåg, Nina Urke
collection PubMed
description Background: Persistent fever after SARS-CoV-2 infection in rituximab-treated patients has been reported. Due to reduced sensitivity in conventional sampling methods and unspecific symptoms in these patients, distinguishing between low-grade viral replication or hyperinflammation is challenging. Antiviral treatment is recommended as prophylactic or early treatment in the at-risk population; however, no defined treatment approaches for protracted SARS-CoV-2 infection exist. Results: We present a case of 96 days of persistent fever and SARS-CoV-2 infection in a patient receiving B cell depletion therapy for multiple sclerosis. Migratory lung infiltrates and positive PCR tests from serum (day-58 post infection) and lower airways (day-90 post infection) confirmed continuous viral replication. The dominant symptoms were continuous high fever, dyspnea and mild to moderate hypoxemia, which never developed into severe respiratory failure. The patient was hospitalized three times, with transient improvement after late antiviral treatment and full recovery 6 months post-rituximab infusion. Conclusions: A strategy for securing samples from lower airways and serum should be a prioritization to strengthen diagnostic certainty in immunocompromised patients. B-cell-deprived patients could benefit from late treatment with SARS-CoV-2-specific monoclonal antibodies and antivirals. Importantly, increased intervals between immunosuppressive therapy should be considered where feasible.
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spelling pubmed-94147202022-08-27 Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment Ertesvåg, Nina Urke Sakkestad, Sunniva Todnem Zhou, Fan Hoff, Ingrid Kristiansen, Trygve Jonassen, Trygve Müller Follesø, Elisabeth Brokstad, Karl Albert Dyrhovden, Ruben Mohn, Kristin G.-I. Viruses Case Report Background: Persistent fever after SARS-CoV-2 infection in rituximab-treated patients has been reported. Due to reduced sensitivity in conventional sampling methods and unspecific symptoms in these patients, distinguishing between low-grade viral replication or hyperinflammation is challenging. Antiviral treatment is recommended as prophylactic or early treatment in the at-risk population; however, no defined treatment approaches for protracted SARS-CoV-2 infection exist. Results: We present a case of 96 days of persistent fever and SARS-CoV-2 infection in a patient receiving B cell depletion therapy for multiple sclerosis. Migratory lung infiltrates and positive PCR tests from serum (day-58 post infection) and lower airways (day-90 post infection) confirmed continuous viral replication. The dominant symptoms were continuous high fever, dyspnea and mild to moderate hypoxemia, which never developed into severe respiratory failure. The patient was hospitalized three times, with transient improvement after late antiviral treatment and full recovery 6 months post-rituximab infusion. Conclusions: A strategy for securing samples from lower airways and serum should be a prioritization to strengthen diagnostic certainty in immunocompromised patients. B-cell-deprived patients could benefit from late treatment with SARS-CoV-2-specific monoclonal antibodies and antivirals. Importantly, increased intervals between immunosuppressive therapy should be considered where feasible. MDPI 2022-08-11 /pmc/articles/PMC9414720/ /pubmed/36016378 http://dx.doi.org/10.3390/v14081757 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Ertesvåg, Nina Urke
Sakkestad, Sunniva Todnem
Zhou, Fan
Hoff, Ingrid
Kristiansen, Trygve
Jonassen, Trygve Müller
Follesø, Elisabeth
Brokstad, Karl Albert
Dyrhovden, Ruben
Mohn, Kristin G.-I.
Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment
title Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment
title_full Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment
title_fullStr Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment
title_full_unstemmed Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment
title_short Persistent Fever and Positive PCR 90 Days Post-SARS-CoV-2 Infection in a Rituximab-Treated Patient: A Case of Late Antiviral Treatment
title_sort persistent fever and positive pcr 90 days post-sars-cov-2 infection in a rituximab-treated patient: a case of late antiviral treatment
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9414720/
https://www.ncbi.nlm.nih.gov/pubmed/36016378
http://dx.doi.org/10.3390/v14081757
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