Table 1.
Demographic data, clinical characteristics, laboratory findings, and prescribed treatments in patients with B-cell depletion and prolonged SARS-CoV-2 infection, Nord Franche-Comté Hospital, 2022–2023.
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | ||
|---|---|---|---|---|---|
| Patients characteristics | |||||
| Sex | F | F | F | M | |
| Age, y | 43 | 65 | 48 | 61 | |
| Underlying comorbidities | Rheumatoid arthritis | Multiple sclerosis | Multiple sclerosis, diabetes mellitus | Multiple sclerosis | |
| Past history of anti-CD20 mAbs (y) | - | Rituximab (2017–2019) | Rituximab (2017–2019) | Rituximab (2018–2019) | |
| Current anti-CD20 mAbs (y) | Rituximab (since 2016) | Ocrelizumab (since 2019) | Ocrelizumab (since 2019) | Ocrelizumab (since 2019) | |
| Other treatments | Leflunomid, CTC | Sitagliptin | |||
| Clinical features | |||||
| Clinical presentation | Onset date | 15 March 2023 | 28 September 2022 | 25 January 2022 | 28 March 2023 |
| Symptoms | Fever, sweating, weight loss, dyspnea | Fever with ILI, cough, dyspnea | Fever, asthenia, cough, dyspnea, retrosternal pain | Fever, cough, sweating, dyspnea | |
| Sounds heard on pulmonary auscultation | Without abnormalities | Unilateral crackling (left) | Unilateral crackling (left) | Bilateral crackling | |
| Oxygen support | 4 L/min | 0 L/min | 0 L/min | 0 L/min | |
| Laboratory findings and microbiological findings | |||||
| NP SARS-CoV-2 RT-PCR | Days from onset (date) | 56 (10 May 2023) | 58 (26 November 2023) | 33 (27 February 2023) | 46 (13 May 2023) |
| Results | Negative | Negative | Negative | Negative | |
| Serology SARS-CoV-2 | Negative | Negative | Negative | Negative | |
| White blood cells count (G/L) | 4.70 | 5.15 | 7.67 | 11.29 | |
| C-reactive protein (mg/L) | 57.53 | 13.44 | 146.79 | 50.07 | |
| Peripheral Blood cultures | Negative | NA | Negative | Negative | |
| BAL | Days from onset (date) | 69 (23 May 2023) | 76 (13 December 2023) | 40 (6 March 2023) | 50 (17 May 2023) |
| Culture | Negative | Negative | Negative | Negative | |
| SARS-CoV-2 RT-PCR Results * (CT if available) | Positive (NA) | Positive (E 33.1-RdRP 35.2-N2 37.0) | Positive (NA) | Positive (QS5 27.8- ORF1ab 27.9-S 27.8) |
|
| Imaging findings | |||||
| Chest X-ray | Bronchial thickening | ND | Interstitial lung, left base condensation | Interstitial lung opacities | |
| Pulmonary CT scan | Bilateral interstitial lung disease, bilateral GGO | Bilateral GGO | Bilateral GGO with a basal distribution | Ground glass and consolidation in middle and lower lobes | |
| Treatments | |||||
| Antimicrobial drugs | 3GC/Piperacillin-tazobactam/Levofloxacine/TMP-SMX | NA | 3GC/Amoxicillin clavulanate/Piperacillin-tazobactam/Spiramycine | 3GC/Amoxicillin clavulanate/Piperacillin-tazobactam/Spiramycine | |
| Specific treatments (drugs) | Remdesivir/IL6-receptor antagonists (TCZ)/ CTC (DXM)/CCP ** |
CCP ** | CPP ** | Remsedevir/Nirmatrelvir-ritonavir/CPP ** | |
| Outcomes | |||||
| Clinical | Recovery | Yes 85 (8 June 2023) |
Yes 88 (25 December 2022) |
Yes 52 (18 March 2023) |
Yes 67 (3 June 2023) |
| Resolution of symptoms from onset, in days (date) | |||||
| Follow-up from recovery, in days (last date) | 24 (1 July 2023) | 186 (30 June 2023) | 49 (5 July 2023) | 32 (5 July 2023) | |
| Microbiological NP SARS-CoV-2 RT-PCR 7 days after CPP administration *** |
Negative | Negative | Negative | Negative | |
Abbreviations (alphabetic order): 3GC: third-generation cephalosporin; BAL: Broncho alveolar lavage; CCP: COVID-19 convalescent plasma; CT: cycle threshold, CTC: corticosteroids therapy; CT scan: computed tomography scan; DXM: dexamethasone; E: envelope gene; F: female; GGO: ground glass opacities; G/L: giga per liter; L/min: liter per minute; ILI: influenza-like illness; N: nucleocapsid gene; NA: not applicable; NP: Nasopharyngeal; ND: not done; M: male; mAbs: monoclonal antibodies (mAbs); mg/L: milligram per liter; ORF1ab: specific Open Reading Frame; RdRP: ARN polymerase gene; RT-PCR: reverse transcription polymerase chain reaction; S: protein S gene; TCZ: tocilizumab; TMP-SMX: Trimethoprim-sulfamethoxazole; y: years. * We performed in all our patients DiagCORE ®, Hong Kong, China, Respiratory Panel 2—SAT Dx., which detects viral and bacterial pathogens including human mastadenovirus A-G (formerly adenovirus), primate bocaparvovirus 1 + 2 (formerly bocavirus), human (hMPV), rhinovirus/enterovirus, influenza A virus (as no subtype, subtype H1, H1N1/2009, or H3), influenza B virus, human respirovirus 1 or 3, human orthorubulavirus 2 or 4 (formerly human parainfluenza virus type 1–4), human orthopneumovirus, Mycoplasma pneumoniae, Legionella pneumophilia, Bordetella pertussis and Chlamydia pneumoniae, coronavirus (differentiating HKU1, NL63, OC43, or 229E), human metapneumovirus A/B, and SARS-CoV-2. Amplification curves and cycle threshold (Ct) values were not mentioned in patient 1 and 3. ** We administered four units of high-titer post-vaccine Omicron COVID-19 convalescent plasma in all patients (two units on day 1 and two units on day 2). *** BAL SARS-CoV-2 RT-PCR follow-up after convalescent plasma administration were not performed in any patients regarding the complete recovery.