Detailed tracking of antigen and antibody levels during coronavirus disease 2019 treatment in an immunosuppressed patient with anti-neutrophil cytoplasmic autoantibody-associated vasculitis

Toshitaka Yukishima; Kazuki Furuhashi; Kumiko Shimoyama; Takeru Taki; Chika Azuma; Kenji Yamazaki; Shogo Furukawa; Soma Fukami; Osanori Nagura; Kazuto Katahashi; Keita Yamashita; Masato Maekawa; Noriyoshi Ogawa

doi:10.1016/j.jiac.2024.02.004

Detailed tracking of antigen and antibody levels during coronavirus disease 2019 treatment in an immunosuppressed patient with anti-neutrophil cytoplasmic autoantibody-associated vasculitis

J Infect Chemother. 2024 Feb 10:S1341-321X(24)00034-5. doi: 10.1016/j.jiac.2024.02.004. Online ahead of print.

Authors

Affiliations

¹ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: 940410hama@gmail.com.
² Infection Control and Prevention Center, Hamamatsu University Hospital, Japan. Electronic address: k.furu@hama-med.ac.jp.
³ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: delph@hama-med.ac.jp.
⁴ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: takeru.1108@icloud.com.
⁵ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: aritamadai821@gmail.com.
⁶ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: rav4skypares@yahoo.co.jp.
⁷ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: nishogo@gmail.com.
⁸ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: 41247385@hama-med.ac.jp.
⁹ Infection Control and Prevention Center, Hamamatsu University Hospital, Japan. Electronic address: rikyo@hama-med.ac.jp.
¹⁰ Second Department of Surgery, Hamamatsu University School of Medicine, Japan. Electronic address: kazukata@hama-med.ac.jp.
¹¹ Department of Laboratory Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: keitay@hama-med.ac.jp.
¹² Department of Laboratory Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: mmaekawa@hama-med.ac.jp.
¹³ Division of Immunology and Rheumatology, Third Department of Internal Medicine, Hamamatsu University School of Medicine, Japan. Electronic address: nogawa@hama-med.ac.jp.

PMID: 38342142
DOI: 10.1016/j.jiac.2024.02.004

Abstract

A 67-year-old woman with anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis was not vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was on multiple immunosuppressive drugs. She was hospitalized because of interstitial shadowing in the lungs and diagnosed with persistent coronavirus disease 2019 (COVID-19). Despite treatment with a recombinant monoclonal antibody and antivirals, her symptoms persisted and she lacked a specific antibody response. She tested negative for SARS-CoV-2 antigen after the second antiviral treatment, and a subsequent chest radiograph showed improvement. However, the antibody levels did not change. This case highlights the importance of careful monitoring of the SARS-CoV-2 antigen and antibody levels during COVID-19 treatment in patients with immunosuppression.

Keywords: Coronavirus disease 2019; Nirmatrelvir/ritonavir; SARS-CoV-2 antibody; SARS-CoV-2 antigen; anti-neutrophil cytoplasmic antibody-associated vasculitis; sotrovimab.

Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.

Publication types

Case Reports