Introduction: COVID-19 continues to pose a significant risk for the immunocompromised. These individuals are more susceptible to recurrent infections and related complications due to a modified immune response. Understanding the modified host-pathogen interactions in this vulnerable population is key to developing effective management strategies.
Description: Our patient was a 62-year-old male with diffuse large B-cell lymphoma (DLBCL), treated with chemotherapy and CAR-T therapy, along with radiation (right lung due to DLBCL). A month into treatment, he had recurrent episodes of symptomatic COVID-19 infection requiring supplemental oxygen, managed as an outpatient twice with Paxlovid and subsequently requiring three hospitalizations. The second to the last admission occurred 4 months post diagnosis where he presented in acute respiratory failure secondary to covid-19 with a very low cycle threshold. He was managed with Remdesevir,Dexamethasone and intravenous immunoglobulins (IVIG).Patient improved and was weaned off of O2 for the first time since COVID-19 diagnosis.Interestingly, during these episodes his tests remained positive. We suspect slowly progressing pneumonia due to protracted COVID-19 infection. A month later he was hospitalized again with testing revealing low cycle threshold and COVID-19 positivity.Despite receiving treatment, the patient unfortunately succumbed to the illness. The family declined an autopsy request.
Discussion: The patient's immunocompromised state, B-cell depleting therapy and the ongoing evolution of the virus were potential factors in enabling the protracted COVID-19 disease course and associated respiratory failure. We want to highlight the unexpected resolution of respiratory failure with the addition of IVIG supporting our hypothesis of persistent infection. Obtaining further insight into this patient population and formulating new treatment strategies is essential.
