Bay Anne Cathrine, Clausen Michael R, Røge Birgit Thorup, Sydenham Thomas V, Steinke Kat, Pedersen Rune Micha, Bang Line L, Andersen Thomas E, Jensen Anders, Madsen Lone W
Department of Internal Medicine, Kolding Hospital, Kolding, Denmark.
Department of Hematology, Vejle Hospital, Vejle, Denmark.
IDCases. 2024 Nov 13;38:e02118. doi: 10.1016/j.idcr.2024.e02118. eCollection 2024.
Immunocompromised patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can have a longer duration of viral shedding and persistence of symptoms. The optimal treatment strategy for these patients remains to be established. This case describes a male in his late sixties with follicular lymphoma and persistent symptoms of infection with SARS-CoV-2 variant BA.2 who was treated with remdesivir five times over a period of six months. The clinical effect of remdesivir treatment decreased over time, and further viral sequencing revealed the emergence of mutations across the SARS-CoV-2 genome. Due to the lack of other treatment options, the patient was treated with a combination of remdesivir and molnupiravir for 10 days, and epcoritamab was discontinued, which led to the cessation of symptoms. This case illustrates the risk of a diminished effect of remdesivir with prolonged use and the need for treatment guidelines for immunocompromised patients with persistent COVID-19.
感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的免疫功能低下患者可能有更长的病毒 shedding 持续时间和症状持续存在。这些患者的最佳治疗策略仍有待确定。本病例描述了一名60多岁晚期患有滤泡性淋巴瘤且感染SARS-CoV-2变异株BA.2后持续出现症状的男性，在六个月的时间里接受了五次瑞德西韦治疗。瑞德西韦治疗的临床效果随时间下降，进一步的病毒测序显示SARS-CoV-2基因组出现了突变。由于缺乏其他治疗选择，该患者接受了瑞德西韦和莫努匹拉韦联合治疗10天，并且停止使用epcoritamab，这导致症状消失。本病例说明了长期使用瑞德西韦效果降低的风险以及对患有持续性新冠肺炎的免疫功能低下患者制定治疗指南的必要性。
