key: cord-0831232-oymg1bba
authors: Karataş, Ayşe; İnkaya, Ahmet Çağkan; Demiroğlu, Haluk; Aksu, Salih; Haziyev, Tahmaz; Çınar, Olgu Erkin; Alp, Alpaslan; Uzun, Ömrüm; Sayınalp, Nilgün; Göker, Hakan
title: Prolonged Viral Shedding in a Lymphoma Patient with COVID-19 Infection Receiving Convalescent Plasma
date: 2020-07-03
journal: Transfus Apher Sci
DOI: 10.1016/j.transci.2020.102871
sha: 52a66a3249c1add69ead8111ea495c670cf42fd1
doc_id: 831232
cord_uid: oymg1bba

Abstract Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China; and spread all over the world. Reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 usually returns to negative in 20 days post-infection, but prolonged positivity has been reported up to 63 days. A case whose viral shedding lasted 60 days is reported from China. Herein we report a patient with a history of autologous stem cell transplantation (ASCT) for lymphoma whose RT-PCR test remained positive for SARS-CoV-2 for 74 days. The prolonged RT-PCR positivity, despite convalescent plasma infusion, may suggest that the given antibodies may be ineffective in terms of viral clearance. In patients with hematological malignancies or immunosuppression, such as ASCT, may lead to prolonged viral shedding, and strict isolation is warranted for long-term SARS-CoV-2 infection control.

Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China; and spread all over the world. Disease, caused by the SARS-CoV-2 virus named coronavirus disease 2019 . The clinical course ranges from asymptomatic infection to severe pneumonia, cytokine release syndrome, and fatal acute respiratory distress syndrome [1] . The mortality of COVID-19 deemed to be correlated with hyper-inflammation. Immunosuppression can suppress the destructive effect of the immune system, slow down virus clearance, and in turn may change the expected course of the disease. Also immunosuppression may have detrimental effects during viral infection [2] .

Innate and adaptive immune responses are fundamental to fight back viral assaults.

Clinical features and prognosis of COVID-19 in immunosuppressed patients may be detrimental at this time [3] . Chemotherapeutic agents and corticosteroids used in the treatment of malignant diseases make the patients more vulnerable to COVID-19 disease by making their immune system even worse [4] .

There is currently no evidence-based specific treatment for COVID-19. Given that the benefit of the current medications is limited, it might be somewhat useful to consider using the convalescent plasma (CP) transfusion as a treatment strategy for critically ill patients [5] . A multicenter clinical trial investigated the clinical effects of CP treatment in critically ill patients. All patients were given standard COVID-19 treatment. CP group was given additional CP. They could not find a statistically significant difference in the time to clinical improvement and the mortality rate in 28 days between the groups. Also, they established delayed viral clearance at 72 hours in the CP group [7] .

Normally, upper respiratory specimens return to negative in 20 days post-infection but prolonged positivity may last to 63 days, and it is mostly reported in severe patients [8, 9] . A case whose viral shedding lasted 60 days is reported from China Our patient had also undergone bone ASCT thus, underlying immunosuppression might lead to prolonged shedding. Unfortunately, we could not perform whole genome sequencing, viral culturing to confirm the detected genome belonged to a viable virus. Furthermore, we can not exclude the possibility of reinfection. Despite, the patient was remained positive in RT-PCR he did not develop any symptoms compatible with COVID-19 after the initial disease course.

In conclusion, to the best of our knowledge this is the longest recorded COVID-19 patient with lymphoma who underwent ASCT with persistent SARS-CoV-2 viral shedding for 74 days, even with the administration of CP. In patients with hematological malignancies or immunosuppression such as ASCT may lead to J o u r n a l P r e -p r o o f prolonged viral shedding and strict medical precautions and isolation rules should be followed for SARS-CoV-2. 

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