SHM Converge Scientific Abstract ePoster Gallery-Extended Anti-Viral Therapy for Covid in an Immunocompromised Patient

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This case describes a 50-year-old woman with rheumatoid arthritis on maintenance rituximab who developed severe COVID-19 pneumonia despite being fully vaccinated and boosted. After an initial hospitalization at an outside hospital, she received 5 days of remdesivir and dexamethasone but worsened after discharge, returning 28 days later with persistent PCR positivity, severe hypoxemia, and extensive bilateral ground-glass and consolidative lung opacities on CT.<br /><br />She was treated again with 5 days of remdesivir, dexamethasone, and cefepime for possible hospital-acquired pneumonia, but repeat imaging showed worsening inflammatory changes. Pulmonary and infectious disease teams considered cryptogenic organizing pneumonia and gave steroids and a monoclonal antibody infusion, but she still had no meaningful improvement after 10 days. Extensive testing for other infectious causes, including fungal infections, Pneumocystis jirovecii, and respiratory viruses, was negative.<br /><br />Given her immunocompromised status from rituximab and concern for persistent SARS-CoV-2 infection, the team decided to restart remdesivir for an extended 14-day course. She improved after several days, gradually weaned to 3 L nasal cannula, and was discharged home on a 10-day course of nirmatrelvir/ritonavir (Paxlovid).<br /><br />At follow-up, she remained on 3 L oxygen with exertional dyspnea but was improving. Pulmonary function tests showed a restrictive pattern and moderately reduced DLCO, consistent with recovery from severe COVID-19. The case highlights that patients receiving rituximab may have prolonged viral shedding, weak vaccine response, and severe persistent infection, and that extended antiviral therapy may be beneficial when standard treatment fails.

Asset Subtitle

Chantel Dockstader

Meta Tag

Author List Chantel Dockstader, Swathi Subramany

Category Clinical Vignettes

Concept COVID-19

Concept Immunocompromised State

Concept Rituximab

Concept Severe Disease

Concept Persistent Infection

Distinguished Non-Finalist

Presenter Organization University of New Mexico Hospital

Presenting Author Chantel Dockstader

Track Adult

Keywords

rheumatoid arthritis

rituximab

severe COVID-19 pneumonia

persistent SARS-CoV-2 infection

remdesivir

dexamethasone

immunocompromised

ground-glass opacities

nirmatrelvir/ritonavir

prolonged viral shedding

COVID-19

Immunocompromised State

Rituximab

Severe Disease

Persistent Infection