Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Department of Intractable Diseases, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
J Infect Chemother. 2022 Jul;28(7):971-974. doi: 10.1016/j.jiac.2022.02.006. Epub 2022 Feb 10.
Corticosteroids are widely used to treat severe COVID-19, but in immunocompromised individuals, who are susceptible to persistent infection, long term corticosteroid use may delay viral clearance. We present a case of prolonged SARS-CoV-2 infection in a man with significantly impaired B-cell immunity due to non-Hodgkin lymphoma which had been treated with rituximab. SARS-CoV-2 shedding persisted, despite treatment with remdesivir. Viral sequencing confirmed the persistence of the same viral strain, ruling out the possibility of reinfection. Although SARS-CoV-2 IgG, IgA and IgM remained negative throughout the treatment period, after reduction of the corticosteroid dose, PCR became negative. Long-term corticosteroid treatment, especially in immunocompromised individuals, may result in suppression of cell-mediated immunity and prolonged SARS-CoV-2 infection.
皮质类固醇被广泛用于治疗严重的 COVID-19，但在易发生持续感染的免疫功能低下个体中，长期使用皮质类固醇可能会延迟病毒清除。我们报告了一例因非霍奇金淋巴瘤而导致 B 细胞免疫严重受损的患者，由于使用利妥昔单抗而持续感染 SARS-CoV-2 的病例。尽管使用瑞德西韦治疗，但 S 蛋白脱落仍持续存在。病毒测序证实了同一病毒株的持续存在，排除了再感染的可能性。尽管在整个治疗期间，SARS-CoV-2 IgG、IgA 和 IgM 均为阴性，但在减少皮质类固醇剂量后，PCR 转为阴性。长期皮质类固醇治疗，特别是在免疫功能低下的个体中，可能导致细胞介导免疫抑制和 SARS-CoV-2 感染延长。
