Casirivimab/imdevimab for active COVID-19 pneumonia persisted for nine months in a patient with follicular lymphoma during anti-CD20 therapy

Hiroyuki Nagai; Makoto Saito; Eisuke Adachi; Yuko Sakai-Tagawa; Seiya Yomayoshi; Maki Kiso; Toyotaka Kawamata; Michiko Koga; Yoshihiro Kawaoka; Takeya Tsutsumi; Hiroshi Yotsuyanagi

doi:10.7883/yoken.JJID.2022.092

This article has now been updated. Please use the final version.

Casirivimab/imdevimab for active COVID-19 pneumonia persisted for nine months in a patient with follicular lymphoma during anti-CD20 therapy

Hiroyuki Nagai, Makoto Saito, Eisuke Adachi, Yuko Sakai-Tagawa, Seiya Yomayoshi, Maki Kiso, Toyotaka Kawamata, Michiko Koga, Yoshihiro Kawaoka, Takeya Tsutsumi, Hiroshi Yotsuyanagi

Author information

Hiroyuki Nagai
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Makoto Saito
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Japan
Eisuke Adachi
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Yuko Sakai-Tagawa
Department of Virology, The Institute of Medical Science, The University of Tokyo, Japan
Seiya Yomayoshi
Department of Virology, The Institute of Medical Science, The University of Tokyo, Japan
The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Japan
Maki Kiso
Department of Virology, The Institute of Medical Science, The University of Tokyo, Japan
Toyotaka Kawamata
Department of Hematology/Oncology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Michiko Koga
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Center for Antibody and Vaccine Therapy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Yoshihiro Kawaoka
Department of Virology, The Institute of Medical Science, The University of Tokyo, Japan
The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Japan
Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, USA
Takeya Tsutsumi
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Japan
Hiroshi Yotsuyanagi
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Japan

Keywords: COVID-19, prolonged viral shedding, viral isolation, immunocompromised host, casirivimab and imdevimab

JOURNAL FREE ACCESS Advance online publication

Article ID: JJID.2022.092

DOI https://doi.org/10.7883/yoken.JJID.2022.092

The final version of this article is now available: Vol. 75 (2022), No. 6 pp. 608-611

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Abstract

Immunocompromised patients are more likely to develop severe COVID-19 and their mortality is high, while it is hypothesized that chronic infection in these patients can be a risk of developing new variants. We describe a patient with prolonged active infection of COVID-19 who became infected during treatment with anti-CD20 antibody (obinutuzumab) for follicular lymphoma. This patient had persistent RT-PCR positivity and live virus isolation for nine months despite treatment with remdesivir and other potential antiviral therapies. The computed tomography image of the chest showed that the viral pneumonia repeatedly appeared and disappeared in different lobes, as if new infection had occurred continuously. His antibody titer of SARS-CoV-2 was negative throughout the illness, even after two doses of BNT162b2 mRNA vaccine given in the seventh month. Combination of monoclonal antibody therapy against COVID-19 (casirivimab and imdevimab) and antivirals resulted in negative RT-PCR and the virus was no longer isolated. The patient was clinically cured. During the 9-month active infection, no fixed mutations in the S protein were detected and the in vitro susceptibility to remdesivir was retained. Therapeutic administration of anti-SARS-CoV-2 monoclonal antibodies is essential for immunocompromised patients. Measures to prevent resistance against these key drugs are in dire need.

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