Journal
BMJ CASE REPORTS
Volume 14, Issue 11, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bcr-2021-246308
Keywords
COVID-19; immunological products and vaccines; infections; malignant disease and immunosuppression; infectious diseases
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This study demonstrates the challenges of treating immunosuppressed patients with COVID-19 pneumonia, showing cases of undetectable adaptive immunity even after vaccination or infection, and the need for specialized monitoring and treatment methods.
Since the beginning of COVID-19 vaccination in New Jersey in December 2020, we have observed multiple cases of undetectable adaptive immunity, post-vaccination or post-COVID-19 infection, in patients using immunosuppressants. Here, we present three cases of patients using immunosuppressants: mycophenolate and tacrolimus for renal transplant; ocrelizumab for multiple sclerosis and rituximab for peripheral ulcerative keratitis. All three patients were admitted for acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia; two patients reported having received full COVID-19 vaccination prior to admission and one unvaccinated patient required readmission. Our findings showed that these patients tested negative for SARS-CoV-2 IgM spike and CoV-2 IgG nucleocapsid antibodies. All three patients were treated with standard-of-care remdesivir, dexamethasone and convalescent plasma; two recovered successfully and one patient died from respiratory failure secondary to worsening ARDS from COVID-19 pneumonia. We highlight the challenges of treating immunosuppressed patients with COVID-19 pneumonia, in an era where dissemination of such information is paramount to helping doctors standardise and improve the quality of care for these patients.
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