Intern Med . Persistent SARS-CoV-2 Infection in a Patient with Nephrotic Syndrome under Rituximab Therapy: Successful Treatment with a Combination of Remdesivir and Monoclonal Antibodies

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Intern Med


. 2022 Sep 28.
doi: 10.2169/internalmedicine.0241-22. Online ahead of print.
Persistent SARS-CoV-2 Infection in a Patient with Nephrotic Syndrome under Rituximab Therapy: Successful Treatment with a Combination of Remdesivir and Monoclonal Antibodies


Akihiro Shimizu ¹ , Izumi Shirai ¹ , Kyohei Ogawa ¹ , Akane Miura ¹ , Kotaro Haruhara ¹ , Kentaro Oshiro ¹ , Akihiko Hamaguchi ¹ , Shinya Yokote ² , Masahiro Okabe ³ , Hiroyuki Ueda ⁴ , Nobuo Tsuboi ⁴ , Masato Ikeda ¹ , Takashi Yokoo ⁴



Affiliations

• PMID: 36171121
• DOI: 10.2169/internalmedicine.0241-22

Abstract

Rituximab is an effective treatment for frequently relapsing/steroid-dependent nephrotic syndrome, but there is concern about infections caused by humoral immunodeficiency. We herein report a case of prolonged (>7 weeks) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old man with minimal-change disease treated with rituximab developed SARS-CoV-2 infection. The clinical response to remdesivir was soon transiently abolished. Treatment with casirivimab and imdevimab (REGEN-COV) monoclonal antibodies in combination with remdesivir resulted in complete clearance of the infection. The REGEN-COV antibody cocktail may improve the outcome of SARS-CoV-2 infection in patients with humoral immunodeficiency.

Keywords: COVID-19; Minimal change disease; REGEN-COV; frequently relapsing/steroid-dependent nephrotic syndrome; monoclonal antibody therapy; rituximab.