Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

Howard Sanders; Christina Callas; Helaine St Amant; Jong Chung; Victoria R Dimitriades; Natasha A Nakra

doi:10.3389/fped.2023.1076686

Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia

Front Pediatr. 2023 Mar 10:11:1076686. doi: 10.3389/fped.2023.1076686. eCollection 2023.

Authors

Howard Sanders¹, Christina Callas¹, Helaine St Amant¹, Jong Chung², Victoria R Dimitriades³, Natasha A Nakra⁴

Affiliations

¹ Department of Pediatrics, University of California Davis Medical School, Sacramento, CA, United States.
² Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of California Davis Medical School, Sacramento, CA, United States.
³ Division of Pediatric Allergy & Immunology, Department of Pediatrics, University of California Davis Medical School, Sacramento, CA, United States.
⁴ Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California Davis Medical School, Sacramento, CA, United States.

Abstract

This report describes a pediatric patient who underwent chimeric antigen receptor (CAR) T-cell therapy for refractory B-cell acute lymphoblastic leukemia (B-ALL) four years prior, with resultant hypogammaglobulinemia for which he was receiving weekly subcutaneous immune globulin. He presented with persistent fever, dry cough, and a tingling sensation in his toes following a confirmed COVID-19 infection 3 weeks prior. His initial nasopharyngeal SARS-CoV-2 PCR was negative, leading to an extensive workup for other infections. He was ultimately diagnosed with persistent lower respiratory tract COVID-19 infection based on positive SARS-CoV-2 PCR from bronchoalveolar lavage (BAL) sampling. He was treated with a combination of remdesivir (antiviral) and casirivimab/imdevimab (combination monoclonal antibodies) with immediate improvement in fever, respiratory symptoms, and neurologic symptoms.

Keywords: CAR-T cell therapy; COVID-19; SARS-CoV-2; hypogammaglobulinemia; pediatric; remdesivir; virus neutralizing monoclonal antibody.

Publication types

Case Reports