Persistent replication of SARS-CoV-2 in a severely immunocompromised patient treated with several courses of remdesivir

Abstract

Microbiological response of SARS-CoV-2 to remdesivir in immunocompromised patients has not been evaluated. We present the case of a severely immunocompromised patient with persistent replication of SARS-CoV-2, who required different courses of remdesivir. Short courses of remdesivir might be insufficient in immunocompromised patients due to prolonged viral clearance.

Keywords: COVID-19; Immunosuppression; Lymphoma; Remdesivir; SARS-CoV-2.

Fig. 1

Microbiological and clinical evolution of SARS-CoV-2 infection. AV: Antiviral treatment (lopinavir/ritonavir, hydroxychloroquine, azithromycin, darunavir/cobicistat). Ch: chemotherapy (prednisone, cyclophosphamide). CRP: C-reactive protein. CS: convalescent serum. IVIG: intravenous immunoglobulin. IS: immunosupression (steroids, anakinra). O2: oxygen support. SpO2/FiO2: oxygen saturation to fraction of inspired oxygen ratio. First graph shows changes on SARS-CoV-2 adjusted viral load in serial nasopharyngeal swabs and the different antiviral treatments received. Adjusted viral load was calculated by adjusting cycle threshold (Ct) for the number of cells per sample and is represented as a logarithm of the number of copies per 1000 cells (log₁₀ copies/1000 cells). Red areas and dashed lines represent time under remdesivir treatment. Grey areas represent time under other antiviral treatment. The following graphs show the evolution of temperature (ºC), SpO2/FiO2, CRP and ferritin. Red areas and dashed lines represent time under remdesivir treatment. The different treatments received are presented in coloured bars.