Mahameed Reem, Even Dar Razi, Khateeb Jasmin, Rakedzon Stav, Stern Anat, Dotan Yaniv
Pulmonary Institute, Rambam Health Care Campus, Haifa, Israel.
Pulmonary Institute, Rambam Health Care Campus, Haifa, Israel, Faculty of Medicine, Technion-Israel Institute of Technology.
Harefuah. 2025 Jul;164(7):418-423.
Patients with immunosuppression due to severe B cell depletion, such as those with hypogammaglobulinemia or those treated with B-cell suppressive medications, may experience prolonged replication and shedding of SARS-CoV-2. Their inability to mount a sufficient antibody response to clear the virus places them at risk for developing persistent pulmonary COVID-19 (PPC). PPC has mainly been described in case reports and case series. An awareness gap exists among physicians as to the risk factors, clinical manifestations and means of diagnosis and treatment of the disease. This article presents five cases of immunocompromised patients who received at least two doses of COVID-19 vaccination and developed PPC, which is defined by the presence of respiratory and systemic symptoms for ≥14 days, typical imaging findings, and a positive COVID-19 PCR test from a nasal swab or bronchoalveolar lavage (BAL). The patients received convalescent plasma during hospitalization, and no adverse effects related to the plasma were documented. Three out of five patients experienced clinical improvement within a few days post-infusion, one showed gradual improvement, and the last patient required multiple doses of plasma in order to achieve a cure. In all cases, there was resolution of pulmonary opacities on imaging, along with a decrease in inflammatory markers. This case series strengthens the importance of awareness and knowledge of the syndrome, and further establishes the efficacy of treatment with convalescent plasma. Additionally, the article discusses indications for convalescent plasma in the treatment of persistent COVID-19 infection in immunosuppressed patients.
因严重B细胞耗竭导致免疫抑制的患者，如患有低丙种球蛋白血症的患者或接受B细胞抑制药物治疗的患者，可能会出现严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的长期复制和脱落。他们无法产生足够的抗体反应来清除病毒，这使他们有患持续性肺部冠状病毒病（PPC）的风险。PPC主要在病例报告和病例系列中有所描述。医生们对该疾病的危险因素、临床表现以及诊断和治疗方法存在认识差距。本文介绍了5例免疫功能低下的患者，他们接种了至少两剂冠状病毒病疫苗并患上了PPC，PPC的定义为呼吸道和全身症状持续≥14天、典型的影像学表现以及鼻拭子或支气管肺泡灌洗（BAL）的冠状病毒病聚合酶链反应（PCR）检测呈阳性。患者在住院期间接受了恢复期血浆治疗，未记录到与血浆相关的不良反应。5名患者中有3名在输注后几天内病情得到临床改善，1名显示逐渐改善，最后1名患者需要多次输注血浆才能治愈。在所有病例中，影像学上肺部混浊均消失，炎症标志物也有所下降。该病例系列强化了对该综合征的认识和了解的重要性，并进一步证实了恢复期血浆治疗的有效性。此外，本文还讨论了恢复期血浆在治疗免疫抑制患者持续性冠状病毒病感染中的应用指征。
