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Case Reports
. 2023 Jan-Feb;37(1):461-467.
doi: 10.21873/invivo.13100.

Prolonged SARS-CoV-2 Infection With Common Features in Two Patients Receiving Anti-CD20 Therapy

Amalia Papanikolopoulou  1 , Vasilis Thimis  2 , Eirini Antonogiannaki  2 , Vasiliki Rapti  2 , Konstantinos Tsiakos  2 , Giannis Krallis  2 , Sofia Ntouraki  2 , Georgios Kokkotis  2 , Emmanouil Panagiotou  2 , Vissaria Sakka  2 , Eleni Kakalou  2 , Thomas Nitsotolis  2 , Garyphallia Poulakou  2 , Konstantinos N Syrigos  2
Affiliations
Case Reports

Prolonged SARS-CoV-2 Infection With Common Features in Two Patients Receiving Anti-CD20 Therapy

Amalia Papanikolopoulou et al. In Vivo. 2023 Jan-Feb.

Abstract

Background/aim: Anti-CD20-depleting monoclonal antibodies predispose patients to the development of severe disease of SARS-CoV-2 infection. These antibodies are given as backbone or maintenance therapy in patients with hematological malignancies and rheumatology diseases, inducing effective B-cell depletion along with antibody-dependent cell-mediated cytotoxicity (ADCC) and disrupting infection-protective antibody responses.

Case report: We describe two cases of prolonged SARS-CoV-2 infection with common features, in two patients receiving anti-CD20 therapies, the first for chronic lymphocytic leukemia (CLL) and the second for rheumatoid arthritis (RA). For CLL patient, despite administration of antiviral therapy, signs and symptoms of SARS-CoV-2 infection persisted for 43 days, with resolution and lymphocyte recovery from day 33. For RA patient, despite administration of two courses of antiviral therapy, signs and symptoms of SARS-CoV-2 infection persisted for 47 days, without resolution and lymphocyte recovery, leading to a fatal outcome due to acute respiratory distress syndrome (ARDS) and unspecified sepsis.

Conclusion: These two cases highlight the risk for persistent SARS-CoV-2 infection in patients treated with anti-CD20 monoclonal antibodies and support a role for cellular immunity recovery for disease control.

Keywords: COVID-19; SARS-CoV-2; cellular immunity; chronic lymphocytic leukemia; obinutuzumab; rheumatoid arthritis; rituximab.

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Conflict of interest statement

All Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Timeline of COVID-19 illness from symptom onset, disease progression and treatment course for both patients. CLL, Chronic lymphocytic leukemia; RA, rheumatoid arthritis; CTPA, computed tomography of the chest; GGO, ground glass opacities; COVID-19, coronavirus disease 2019; IgG, immunoglobulin G; NP, nasopharyngeal; PCR, polymerase chain reaction; MV, mask venturi; NRM, non-rebreathing mask.
Figure 2
Figure 2. Radiographic imaging of the first patient during COVID-19 illness. (a) Chest radiograph on day 2 of illness with bilateral hazy opacities. (b) Computed tomography pulmonary angiogram (CTPA) on day 2 of illness with bilateral ground glass opacities (GGO) infiltrates. (c) CTPA on day 12 of illness with GGO infiltrates and stripped atelectasis with a new ozomophic lesion in the periphery of right upper lobe (RUL). (d) CTPA on day 23 of illness with old GGO infiltrates increased in both lungs and new condenser hobs with peripheral location. (e) Chest CT on day 43 of illness with old GGO infiltrates diminished and a residual ozomophic lesion still depicted in anterior segment of RUL.
Figure 3
Figure 3. Radiographic imaging of the second patient during COVID-19 illness. (a) Chest radiograph on day 3 of illness with bilateral hazy opacities. (b) Computed tomography pulmonary angiogram (CTPA) on day 3 of illness with bilateral ground glass opacities (GGO) filtrates. (c) CTPA on day 21 of illness with new lesions of multifocal patchy GGO in both lungs.
See this image and copyright information in PMC

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