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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Tuesday, January 21, 2025
Persistent COVID-19 infection in patients undergoing B-cell immunosuppressive therapy may be caused by impaired T-cell responses, according to a case report published in BMC Infectious Diseases. Additional studies should focus on identifying the immunologic defects that may underlie these clinical findings, suggested Xiaohua Chen, MD, of Shanghai Sixth People’s Hospital, China, and colleagues.
The patient was a 68-year-old female with a medical history of chronic lymphocytic leukemia (CLL) on ibrutinib maintenance therapy. She presented to a local hospital with complaints of fever, cough, and progressively worsening shortness of breath. A CT chest scan showed multiple ground-glass nodules in her bilateral lungs, and a nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2). She was subsequently hospitalized and started on a 7-day course of the antiviral azvudine while concurrently receiving treatment with ibrutinib and corticosteroids. Given that she continued to worsen clinically, a repeat CT chest scan demonstrated significant progression of the ground-glass opacities in the patient’s bilateral lungs and a new right upper-lobe lesion.
Additional analyses showed evidence of leukocytopenia, thrombocytopenia, lymphopenia, elevated ferritin, interleukin-6, and C-reactive protein, and significant hypogammaglobulinemia. In addition, flow cytometry showed a substantial reduction in the levels of natural killer (NK) cells, CD4-positive T cells, and CD8-positive T cells. However, the number of CD19-positive B cells remained within normal limits, and the levels of Omnicron antibodies were elevated.
The patient was initially started on dexamethasone, molnupiravir, and piperacillin/tazobactam. Per the respective recommendations of hematology and interventional radiology, ibrutinib was discontinued on day 2 of admission, and piperacillin/tazobactam was switched to imipenem. SARS–CoV-2 levels were then undetectable, and an improvement in the levels of NK cells, CD4-positive T cells, and CD8-positive T cells was observed. Since her discharge, she has resumed taking ibrutinib and is clinically stable.
Disclosure: The study authors reported no conflicts of interest.
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