Successful remdesivir treatment of coronavirus OC43 pneumonia in a lung transplant recipient

Lung transplantation is a well-established treatment for end-stage lung disease. Viral infections represent major infective complications after lung transplantation. Respiratory viruses can increase immune responses and the development of acute rejection. We describe the case of a 60-year-old man, who underwent bilateral lung transplantation in July 2023. He was admitted to our Unit in December 2024 for worsening shortness of breath associated to dry cough. Arterial blood gas analysis on room air showed respiratory failure. RT-PCR panel for respiratory viruses on a specimen obtained from bronchoalveolar lavage fluid came out positive for <i>Coronavirus OC43,</i> while chest CT-scan showed bilateral patchy infiltrates. Based on <i>in vitro</i> activity data, authorized off-label therapy with remdesivir was administered for 5 days Clinical conditions, together with laboratory data and arterial blood gas analysis, improved quickly. In conclusion, viral infections are a major clinical issue after lung transplant, however targeted therapy is not always possible. New treatment options are needed even to prevent complications, such as acute rejection. This clinical case suggests remdesivir could have a role in non-SARS-CoV-2 coronavirus infections.