Severe relapse of SARS-CoV-2 infection in a kidney transplant recipient with negative nasopharyngeal SARS-CoV-2 RT-PCR after rituximab.

Abstract

Immunocompromised patients may experience prolonged viral shedding after their initial SARS-CoV-2 infection, however, symptomatic relapses after remission currently remain rare. We herein describe a severe COVID-19 relapse case of a kidney transplant recipient (KTR) following rituximab therapy, 3 months after a moderate COVID-19 infection, despite viral clearance after recovery of the first episode. During the clinical relapse, the diagnosis was established on a broncho-alveolar lavage specimen (BAL) by RT-PCR. The infectivity of the BAL sample was confirmed on a cell culture assay. Whole genome sequencing confirmed the presence of an identical stain (Clade 20A). However, it had an acquired G142D mutation and a larger deletion of 3-amino-acids at position 143-145. These mutations located within the N-terminal domain are suggested to play a role in viral entry. The diagnosis of a COVID-19 relapse should be considered in the setting of unexplained persistent fever and/or respiratory symptoms in KTRs (especially for those after rituximab therapy), even in patients with previous negative naso-pharyngeal SARS-CoV-2 PCR.

• Authors: Antoine Morel, Sandrine Imbeaud, Anne Scemla, Hélène Péré, Jacques Fourgeaud, Lucile Amrouche, Nicolas Robillard, Delphine Planas, Julien Puech, Sylvie Simon, Fanny Lanternier, Laurent Bélec, Julien Zuber, Olivier Schwartz, Dany Anglicheau, Nathalie Chavarot, David Veyer
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 22 Issue 8 Pg. 2099-2103 (08 2022) ISSN: 1600-6143 [Electronic] United States
• PMID: 35150193 (Publication Type: Case Reports)
• Copyright: © 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.

Chemical References

• Rituximab

Topics

• COVID-19
• COVID-19 Testing
• Humans
• Kidney Transplantation (adverse effects)
• Recurrence
• Reverse Transcriptase Polymerase Chain Reaction
• Rituximab (therapeutic use)
• SARS-CoV-2 (genetics)