J Korean Med Sci.  2023 Jun;38(22):e175. 10.3346/jkms.2023.38.e175.

Within-Host Evolution of SARS-CoV-2 in a B-Cell Depleted Patient With Successful Treatment

• Baek YJ
• Park G
• Choi JY
• Kim EJ
• Kim BI
• Gwack J
• Jung JY

• KMID: 2542806
• DOI: http://doi.org/10.3346/jkms.2023.38.e175

Abstract

Prolonged viral shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an immunocompromised host is a challenge as the treatment and infection control for chronic coronavirus disease 2019 infection is not well established and there is a potential risk of new variants emerging. A 48-year-old woman who underwent chemotherapy, including rituximab and steroid, had reactivation of SARS-CoV-2 68 days after the virus was first detected. She successfully recovered after receiving convalescent plasma and intravenous immunoglobulin. Genomic analysis demonstrated that viruses collected from the nasopharyngeal specimens at day 0 and day 68 had 18 different nucleotide mutations, implying within-host evolution after in-depth epidemiologic investigation.

Keyword

Coronavirus Disease 2019; Immunodeficiency; SARS-CoV-2; Within-Host Evolution

Figure

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  Fig. 1 Chest computed tomography scan of the immunocompromised patient at diagnosis of (A) drug-induced pneumonitis and (B) reactivation of severe acute respiratory syndrome coronavirus 2.

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  Fig. 2 Timeline of treatments and test results of the patient who underwent treatment for lymphoma, drug-induced pneumonitis, and COVID-19 infection.DI-ILD = drug-induced interstitial lung disease, COVID-19 = coronavirus disease 2019, MPL = methylprednisolone, PL = prednisolone, IVIG = intravenous immunoglobulin, PCR = polymerase chain reaction, NP = nasopharyngeal, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

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  Fig. 3 Phylogenetic analysis of severe acute respiratory syndrome coronavirus 2 collected initially and at reactivation of coronavirus disease 2019 infection.SNP = single nucleotide polymorphism.

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