Seventy-day Shedding of SARS-CoV-2 in an Immunocompromised Patient with CLL – A Case Study
A team of American and British experts published the case of a 71-year-old woman with chronic lymphocytic leukemia (CLL) and hypogammaglobulinemia who tested positive for SARS-CoV-2. Despite an asymptomatic course of infection, virus shedding was documented for up to 10 weeks, and viral RNA presence was detected for 15 weeks after the initial detection. The longest recorded virus shedding at the time of the article's publication was 20 days after the first positive test result.
Case Description
A 71-year-old woman with CLL and acquired hypogammaglobulinemia underwent spine surgery for a vertebral fracture on February 14, 2020, and was transferred to a rehabilitation facility on February 19. She was re-hospitalized on February 25 due to anemia and underwent chest x-ray and CT scans with normal findings.
Due to the occurrence of COVID-19 infection in the rehabilitation facility, the patient was tested for SARS-CoV-2 on March 2, resulting in a positive result, and was placed in isolation. As part of her therapy, she received intravenous immunoglobulin (prepared before the COVID-19 pandemic) on April 6 and May 6.
Specific antibodies against SARS-CoV-2 were not detected in the patient. Seventy-one days after the initial virus detection (May 12), she received 200 ml of SARS-CoV-2 convalescent plasma, and this treatment was repeated from a different donor 82 days after the initial virus detection (May 23) due to persistent positive nasopharyngeal swabs. All oropharyngeal swabs were negative.
Test Results and Conclusion
The presence of SARS-CoV-2 was tested a total of 15 times over 15 weeks. Until the 70th day after the first positive test, virus shedding was confirmed, and viral RNA was detected until the 105th day. This case study highlights the possibility of prolonged SARS-CoV-2 shedding in immunocompromised patients.
The authors also describe significant evolution in the genome of the virus isolated from the same patient, which did not affect the kinetics of its replication.
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Source: Avanzato V. A., Matson M. J., Seifert S. N. et al. Case study: prolonged infectious SARS-CoV-2 shedding from an asymptomatic immunocompromised individual with cancer. Cell 2020 Dec 23; 183 (7): 1901−1912.e9, doi: 10.1016/j.cell.2020.10.049.
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