Persistent COVID-19 in an Immunocompromised Patient Temporarily Responsive to Two Courses of Remdesivir Therapy

Abstract

The antiviral drug remdesivir has been shown clinically effective for treatment of COVID-19. We here demonstrate suppressive but not curative effect of remdesivir in an immunocompromised patient. A man in his fifties treated with chemoimmunotherapy for chronic lymphocytic leukemia experienced a 9-week course of COVID-19 with high fever and severe viral pneumonia. During two 10-day courses of remdesivir starting 24 and 45 days after fever onset, pneumonia and spiking fevers remitted, but relapsed after discontinuation. Kinetics of temperature, C-reactive protein, and lymphocyte counts mirrored the remitting/relapsing SARS-CoV-2 infection. Combination therapy or longer treatment duration may be needed in immunocompromised patients.

Keywords: COVID-19; SARS-CoV-2; case report; immunocompromised; remdesivir.

Figure 1.

Timeline of hospital admissions, treatments, and tests for SARS-CoV-2 (A); radiology (B); and kinetics of temperature, C-reactive protein, platelet, and lymphocyte counts (C) before, during, and after treatment with remdesivir. A and B, Blue arrows indicate the day of infusion of convalescent plasma. A, Orange boxes for SARS-CoV-2 PCR represent positive tests; grey boxes for SARS-CoV-2 antibody and PCR represent negative tests. *Ct value not available for this test. C, Grey shade indicates the time period of remdesivir treatment. Abbreviations: CRP, C-reactive protein; Ct, cycle threshold; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.