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 Sep;30(9):922-927. doi: 10.1016/j.jiac.2024.02.004. Epub 2024 Feb 10.

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / blood
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / drug therapy
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / immunology
  • Antibodies, Viral / blood
  • Antibodies, Viral / immunology
  • Antigens, Viral / immunology
  • Antiviral Agents / therapeutic use
  • COVID-19 Drug Treatment
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • COVID-19* / immunology
  • Female
  • Humans
  • Immunocompromised Host*
  • Immunosuppressive Agents / therapeutic use
  • SARS-CoV-2* / immunology

Substances

  • Antibodies, Viral
  • Immunosuppressive Agents
  • Antiviral Agents
  • Antigens, Viral