29 June 2024
: Case report 
A 67-Year-Old Man with Chronic Lymphocytic Leukemia (CLL) on Maintenance Therapy with Ibrutinib with Persistent SARS-CoV-2 Infection Unresponsive to Antiviral Treatments
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment
Flavia Sanmartin1ABCDEF*, Eugenia Magrini1ABCDEF, Emanuele Rando1CDEF, Paola Del Giacomo2AF, Alex Dusina2AF, Elena Matteini1B, Andrea Carbone1B, Giuseppe Puma1B, Gabriele Maria Leanza1B, Federico Frondizi1B, Idanna Innocenti3C, Giuseppe Maiuro2A, Flora Marzia Liotti2ABCDE, Rosaria Santangelo2CD, Luca Laurenti3AB, Antonella Cingolani2ABDEDOI: 10.12659/AJCR.941165
Am J Case Rep 2024; 25:e941165
Table 1. Representation of previous similar clinical cases described in the literature and involving different anti-SARS-CoV-2 therapeutic regimens associated with hematological disease and outcome.
| Author | Diagnosis | Disease related to Covid-19 | Oxygen therapy | Positive period | |
|---|---|---|---|---|---|
| 1 | Helleberg et al (2020) []22 | Chronic lymph. leukemia | Interstitial pneumonia | Yes | 65 days |
| Magyari et al (2022) []21 | B-cell depleted hematological patients | Interstitial pneumonia | Yes | Unknown | |
| 3 | Seki et al (2022) []23 | Non-Hodgkin lymphoma | Interstitial pneumonia | Yes | 60 days |
| 4 | Seki et al (2022) []23 | Multiple myeloma | Interstitial pneumonia | Yes | >30 days |
| 5 | Baldi et al (2022) []13 | Non-Hodgkin lymphoma | Interstitial pneumonia | Yes | 40 days |
| 6 | Graziani et al 2022) []14 | Non-Hodgkin lymphoma | Interstitial pneumonia | Yes | 55 days |
| 7 | Graziani et al (2022) []14 | Non-Hodgkin lymphoma | Interstitial pneumonia | Yes | >50 days |
| 8 | Ford et al (2022) []16 | B-cell acute lymph, leukemia | Interstitial pneumonia | Yes | 120 days |
| This table presents some clinical cases described in the literature with explication of the following details: authors with bibliographic references, diagnosis of patient’s hematological disease, disease related to COVID-19, oxygen-therapy in relation to the presence of respiratory failure, positive time (expressed in days), anti-COVID-19 therapeutic regimens (remdesivir, sotrovimab, corticosteroids, convalescent plasma, nirmatrelvir/ritonavir as Paxlovid, molnupiravir) with reference to the mode of administration (i.v.: intravenous; p.o.: oral), outcome expressed as positivity or negativity to SARS-CoV-2 antigenic or molecular test, immunosuppressive therapy before starting anti-SARS-CoV-2 treatment, and anti-SARS-CoV-2 vaccine (expressed as Yes, Not or Unknown). | |||||
| Anti-Covid-19 therapeutic regimens | Outcome | Immunosuppressive therapy | Anti-sars-CoV-2 vaccine | ||
| 1 | – Remdesivir 10 days i.v.– Remdesivir 10 days i.v. + convalescent plasma i.v. | Negative | Fludarabina, cyclophosphamide rituximab | Unknown | |
| 2 | – Remdesivir 5 days i.v.– convalescent plasma i.v. | Negative | Rituximab | Unknown | |
| 3 | – Sotrovimab i.v.– Remdesivir 5 days i.v.+ Corticosteroids i.v.– Molnupiravir 5 days p.o. + gamma globulin i.v. + corticosteroids i.v. | Death | CHOP, baricitinib | Yes | |
| 4 | – Remdesivir 5 days + sotrovimab i.v.– Corticosteroids i.v.vMolnupiravir 5 days p.o. + sotrovimab i.v. | Persistent positive | Lenalidomide, dexamethasone | Yes | |
| 5 | – Sotrovimab i.v.– Remdesivir 7 days i.v. + Paxlovid 5 days p.o. + corticosteroids i.v. | Negative | Rituximab | Yes | |
| This table presents some clinical cases described in the literature with explication of the following details: authors with bibliographic references, diagnosis of patient’s hematological disease, disease related to COVID-19, oxygen-therapy in relation to the presence of respiratory failure, positive time (expressed in days), anti-COVID-19 therapeutic regimens (remdesivir, sotrovimab, corticosteroids, convalescent plasma, nirmatrelvir/ritonavir as Paxlovid, molnupiravir) with reference to the mode of administration (i.v.: intravenous; p.o.: oral), outcome expressed as positivity or negativity to SARS-CoV-2 antigenic or molecular test, immunosuppressive therapy before starting anti-SARS-CoV-2 treatment, and anti-SARS-CoV-2 vaccine (expressed as Yes, Not or Unknown). | |||||
| 6 | – Sotrovimab i.v.– Paxlovid 5 days p.o. | Negative | Obinutuzumab | Unknown | |
| 7 | – Sotrovimab i.v.– Remdesivir 5 days i.v.– Paxlovid 5 days p.o. | Persistent positive | Rituximab | Unknown | |
| 8 | – Sotrovimab i.v.– Remdesivir 10 days i.v.– Remdesivir 5 days i.v. + Paxlovid 10 days p.o. + Paxlovid 10 days p.o. (corticosteroids i.v.) | Negative | Rituximab | Unknown | |
| This table presents some clinical cases described in the literature with explication of the following details: authors with bibliographic references, diagnosis of patient’s hematological disease, disease related to COVID-19, oxygen-therapy in relation to the presence of respiratory failure, positive time (expressed in days), anti-COVID-19 therapeutic regimens (remdesivir, sotrovimab, corticosteroids, convalescent plasma, nirmatrelvir/ritonavir as Paxlovid, molnupiravir) with reference to the mode of administration (i.v.: intravenous; p.o.: oral), outcome expressed as positivity or negativity to SARS-CoV-2 antigenic or molecular test, immunosuppressive therapy before starting anti-SARS-CoV-2 treatment, and anti-SARS-CoV-2 vaccine (expressed as Yes, Not or Unknown). | |||||