Abstract：
BACKGROUND SARS-CoV-2 infection can persist in immunocompromised patients with hematological malignancies, despite antiviral treatment. This report is of a 67-year-old man with chronic lymphocytic leukemia (CLL), secondary hypogammaglobulinemia, and thrombocytopenia on maintenance therapy with ibrutinib, with persistent SARS-CoV-2 infection unresponsive to antiviral treatment, including remdesivir, nirmatrelvir/ritonavir (Paxlovid), and tixagevimab/cilgavimab (Evusheld). CASE REPORT The patient was admitted to our hospital 3 times. During his first hospitalization, he was treated with 5-day course of remdesivir and intravenous steroids; however, antigen and molecular nasopharyngeal swabs were persistently positive, and he was discharged home. Due to respiratory worsening, he was rehospitalized, and despite being treated initially with tixagevimab/cilgavimab, and subsequently with a remdesivir course of 5 days, SARS-CoV-2 tests remained persistently positive. During his third hospital stay, our patient was subjected to combined therapy with remdesivir and nirmatrelvir/ritonavir for 5 days, obtaining a significant reduction of viral load at both antigen and molecular testing. As an ultimate attempt to achieve a negative status before discharge, a 10-day course of combined remdesivir and nirmatrelvir/ritonavir was administered, with a temporary reduction of viral load, followed by a sudden increase immediately after the discontinuation of Paxlovid. Due to worsening hematological disease and bacterial over-infections, the patient gradually worsened until death. CONCLUSIONS This is an emblematic case of correlation between persistent SARS-CoV-2 infection and immunosuppression status in hematological hosts. In these patients, the viral load remains high, favoring the evolution of the virus, and the immunodeficiency makes it difficult to identify the appropriate therapeutic approach.
摘要：
背景技术SARS-CoV-2感染可在患有血液系统恶性肿瘤的免疫功能低下患者中持续存在,尽管抗病毒治疗。这份报告是关于一名67岁患有慢性淋巴细胞白血病（CLL）的男性，继发性低球蛋白血症,伊布鲁替尼维持治疗的血小板减少症，持续的SARS-CoV-2感染对抗病毒治疗无反应，包括Remdesivir,尼马特雷韦/利托那韦（Paxlovid），和tixagevimab/cilgavimab（Evusheld）。病例报告患者入院3次。在他第一次住院期间，他接受了为期5天的瑞德西韦和静脉注射类固醇治疗；然而，抗原和分子鼻咽拭子持续阳性，他出院回家了.由于呼吸恶化，他住院了,尽管最初接受了tixagevimab/cilgavimab治疗，随后进行了为期5天的remdesivir课程，SARS-CoV-2测试持续呈阳性。在他第三次住院期间，我们的患者接受了雷德西韦和尼马特雷韦/利托那韦的联合治疗5天，在抗原和分子测试中获得病毒载量的显着减少。作为在出院前达到消极状态的最终尝试，一个10天的疗程的联合雷德西韦和尼马特雷韦/利托那韦给药，随着病毒载量的暂时减少，随后在Paxlovid停药后立即突然增加。由于血液病恶化和细菌过度感染，患者逐渐恶化直至死亡。结论这是持续性SARS-CoV-2感染与血液宿主免疫抑制状态之间相关性的一个代表性案例。在这些患者中,病毒载量仍然很高，有利于病毒的进化，免疫缺陷使得很难确定合适的治疗方法。
