Department of Infectious Disease, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108563, Japan.
Department of Hematology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108563, Japan.
Medicina (Kaunas). 2023 Jan 4;59(1):108. doi: 10.3390/medicina59010108.
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). There are many unknowns regarding the handling of long-term SARS-CoV-2 infections in immunocompromised patients. Here, we describe the lethal disease course in a SARS-CoV-2-infected patient during Bruton's tyrosine kinase inhibitor therapy. We performed whole-genome analysis using samples obtained during the course of the disease in a 63-year-old woman who was diagnosed with intraocular malignant lymphoma of the right eye in 2012. She had received treatment since the diagnosis. An autologous transplant was performed in 2020, but she experienced a worsening of the primary disease 26 days before she was diagnosed with a positive SARS-CoV-2 RT-PCR. Tirabrutinib was administered for the primary disease. A cluster of COVID-19 infections occurred in the hematological ward while the patient was hospitalized, and she became infected on day 0. During the course of the disease, she experienced repeated remission exacerbations of COVID-19 pneumonia and eventually died on day 204. SARS-CoV-2 whole-viral sequencing revealed that the patient shed the virus long-term. Viral infectivity studies confirmed infectious virus on day 189, suggesting that the patient might be still infectious. This case report describes the duration and viral genetic evaluation of a patient with malignant lymphoma who developed SARS-CoV-2 infection during Bruton's tyrosine kinase inhibitor therapy and in whom the infection persisted for over 6 months.
新型冠状病毒病（COVID-19）是由严重急性呼吸系统综合征 2 型（SARS-CoV-2）引起的新发传染病。对于免疫功能低下患者中长期 SARS-CoV-2 感染的处理，存在许多未知因素。在此，我们描述了一名在布鲁顿酪氨酸激酶抑制剂治疗期间感染 SARS-CoV-2 的患者的致命疾病过程。我们对一名 63 岁女性在疾病过程中获得的样本进行了全基因组分析，该女性于 2012 年被诊断为右眼眼内恶性淋巴瘤。自诊断以来，她一直在接受治疗。2020 年进行了自体移植，但在被诊断出 SARS-CoV-2 RT-PCR 阳性的 26 天前，她的原发性疾病恶化。为治疗原发性疾病，给予了替拉鲁替尼。在患者住院期间，血液科病房发生了 COVID-19 感染集群，她于第 0 天感染。在疾病过程中，她反复经历 COVID-19 肺炎的缓解和恶化，最终于第 204 天死亡。SARS-CoV-2 全病毒测序显示，该患者长期排出病毒。病毒感染力研究证实第 189 天有传染性病毒，表明该患者可能仍具有传染性。本病例报告描述了一名恶性淋巴瘤患者在布鲁顿酪氨酸激酶抑制剂治疗期间发生 SARS-CoV-2 感染以及感染持续超过 6 个月的情况，包括感染的持续时间和病毒遗传评估。
