Resolution of one-year persisting COVID-19 pneumonia and development of immune thrombocytopenia in a follicular lymphoma patient with preceding rituximab maintenance therapy: a follow-up report and literature review of cases with prolonged infections

Yasuda, Hajime; Mori, Yosuke; Chiba, Asako; Bai, Jie; Murayama, Goh; Matsushita, Yasushi; Miyake, Sachiko; Komatsu, Norio

Background: We previously reported elsewhere of a follicular lymphoma patient suffering from persistent COVID-19 pneumonia that was still ongoing at 2 months after onset. Materials and Methods: We provide a follow-up report of the case along with a literature review of immunocompromised lymphoma patients experiencing prolonged COVID-19 infections. Results: Although requiring a full 1 year, the presented case eventually achieved spontaneous resolution of COVID-19 pneumonia. Anti-SARS-CoV-2 antibodies could not be detected throughout the disease course, but COVID-19-directed T-cell response was found to be intact. The patient also developed secondary immune thrombocytopenia subsequent to COVID-19 pneumonia. We found 19 case reports of immunocompromised lymphoma patients with prolonged COVID-19 infections in the literature. All 5 patients who died did not receive convalescent plasma therapy, whereas resolution of COVID-19 infection was achieved in 8 out of 9 patients who received convalescent plasma therapy. Conclusions: We demonstrate through the presented case that while time-consuming, resolution of COVID-19 infections may be achieved without aid from humoral immunity if cellular immunity is intact. Immunocompromised lymphoma patients are at risk of a prolonged disease course of COVID-19, and convalescent plasma therapy may be a promising approach in such patients. Micro-abstract: Persisting clinical infections and prolonged viral shedding of COVID-19 in immunocompromised patients is a rapidly emerging issue of concern. Persisting COVID-19 infections not only threaten the well-being of the patient, but may also be a potential long-term contagious threat to the environment, and special care must be provided concerning in-hospital isolation and self-quarantine periods. We report an immunocompromised lymphoma patient recovering from a 1-year disease course of COVID-19 pneumonia along with a review of the literature.