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
Influenza Centre, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway.
Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
Viruses. 2022 Aug 11;14(8):1757. doi: 10.3390/v14081757.
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. 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. 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.
据报道，接受利妥昔单抗治疗的患者在感染新型冠状病毒后会持续发热。由于这些患者传统采样方法的敏感性降低且症状不具特异性，区分低度病毒复制或炎症反应过度具有挑战性。对于高危人群，建议进行抗病毒治疗作为预防或早期治疗；然而，对于持续性新型冠状病毒感染，尚无明确的治疗方法。我们报告了一例接受B细胞清除疗法治疗多发性硬化症的患者，持续发热96天且感染新型冠状病毒的病例。游走性肺部浸润以及血清（感染后第58天）和下呼吸道（感染后第90天）的聚合酶链反应检测呈阳性，证实病毒持续复制。主要症状为持续高热、呼吸困难和轻度至中度低氧血症，从未发展为严重呼吸衰竭。该患者住院三次，在晚期抗病毒治疗后短暂好转，并在利妥昔单抗输注6个月后完全康复。确保从下呼吸道和血清采集样本的策略应作为优先事项，以增强免疫功能低下患者的诊断确定性。B细胞缺乏的患者可能会从新型冠状病毒特异性单克隆抗体和抗病毒药物的晚期治疗中获益。重要的是，在可行的情况下应考虑增加免疫抑制治疗的间隔时间。
