tetano
Editor, Senior Moderator
IDCases
. 2025 Mar 22:40:e02199.
doi: 10.1016/j.idcr.2025.e02199. eCollection 2025. Case report: Persistent COVID-19 in a patient with B cell lymphoma refractory to antiviral treatment due to resistance to Remdesivir
Luiz Eduardo Ceccon Calil de Assumpção[SUP] 1 [/SUP], Bruno Graciano Ponce Romeo[SUP] 1 [/SUP], João Carlos de Campos Guerra[SUP] 2 [/SUP], Luis Fernando Aranha Camargo[SUP] 1 2 [/SUP], Marcelo Akira Nagaoka[SUP] 1 [/SUP], Deyvid Emanuel Amgarten[SUP] 2 [/SUP], Erick Gustavo Dorlass[SUP] 2 [/SUP], Roberta Cardoso Petroni[SUP] 2 [/SUP], Afonso Celso Almeida Cardoso[SUP] 2 [/SUP], Renato de Mello Ruiz[SUP] 2 [/SUP], Carolina Devite Bittante[SUP] 2 [/SUP], Vanessa Damazio Teich[SUP] 2 [/SUP], João Renato Rebello Pinho[SUP] 2 [/SUP], André Mario Doi[SUP] 1 2 [/SUP]
Affiliations
Background: There is a significant concern of the pandemic impact of SARS-CoV-2 infection in immunocompromised patients. These patients can develop long COVID-19 due to impairment of cellular and humoral immunity. On the other hand, prolonged infection can lead to mutations in the SARS CoV-2 genome that can impact on the resistance to antiviral therapy. Remdesivir cases have been reported in patients receiving antiviral drug treatment.
Case presentation: A 46-year-old male with previous mantle cell lymphoma resolved by autologous bone marrow transplantation without other comorbidities had SARS-CoV-2 detected in February 2022 and received the recommended antiviral treatment with Remdesivir. COVID-19 evolved in four months with worsening of the symptoms, despite an initial rapid improvements and high RT-PCR Ct values. The patient was relieved from hospital care stable and well but still maintaining positive test results.
Conclusions: the patient presented prolonged COVID-19 with persistence of virus detected by RT-PCR for several months. The strain sequenced presented a mutation different from all reported previously. Although it was no possible to sequence the initial strain without these mutations, our data suggests that immunocompromised patient with prolonged COVID-19 may serve as reservoir for strains of SARS-CoV-2 with resistant components in his genome.
Keywords: Antiviral; COVID; Coronavirus; Immunosuppressed; Mutation; Remdesivir; Resistance; SARS-CoV-2.
. 2025 Mar 22:40:e02199.
doi: 10.1016/j.idcr.2025.e02199. eCollection 2025. Case report: Persistent COVID-19 in a patient with B cell lymphoma refractory to antiviral treatment due to resistance to Remdesivir
Luiz Eduardo Ceccon Calil de Assumpção[SUP] 1 [/SUP], Bruno Graciano Ponce Romeo[SUP] 1 [/SUP], João Carlos de Campos Guerra[SUP] 2 [/SUP], Luis Fernando Aranha Camargo[SUP] 1 2 [/SUP], Marcelo Akira Nagaoka[SUP] 1 [/SUP], Deyvid Emanuel Amgarten[SUP] 2 [/SUP], Erick Gustavo Dorlass[SUP] 2 [/SUP], Roberta Cardoso Petroni[SUP] 2 [/SUP], Afonso Celso Almeida Cardoso[SUP] 2 [/SUP], Renato de Mello Ruiz[SUP] 2 [/SUP], Carolina Devite Bittante[SUP] 2 [/SUP], Vanessa Damazio Teich[SUP] 2 [/SUP], João Renato Rebello Pinho[SUP] 2 [/SUP], André Mario Doi[SUP] 1 2 [/SUP]
Affiliations
- PMID: 40226209
- PMCID: PMC11986235
- DOI: 10.1016/j.idcr.2025.e02199
Background: There is a significant concern of the pandemic impact of SARS-CoV-2 infection in immunocompromised patients. These patients can develop long COVID-19 due to impairment of cellular and humoral immunity. On the other hand, prolonged infection can lead to mutations in the SARS CoV-2 genome that can impact on the resistance to antiviral therapy. Remdesivir cases have been reported in patients receiving antiviral drug treatment.
Case presentation: A 46-year-old male with previous mantle cell lymphoma resolved by autologous bone marrow transplantation without other comorbidities had SARS-CoV-2 detected in February 2022 and received the recommended antiviral treatment with Remdesivir. COVID-19 evolved in four months with worsening of the symptoms, despite an initial rapid improvements and high RT-PCR Ct values. The patient was relieved from hospital care stable and well but still maintaining positive test results.
Conclusions: the patient presented prolonged COVID-19 with persistence of virus detected by RT-PCR for several months. The strain sequenced presented a mutation different from all reported previously. Although it was no possible to sequence the initial strain without these mutations, our data suggests that immunocompromised patient with prolonged COVID-19 may serve as reservoir for strains of SARS-CoV-2 with resistant components in his genome.
Keywords: Antiviral; COVID; Coronavirus; Immunosuppressed; Mutation; Remdesivir; Resistance; SARS-CoV-2.