Resilience and Beyond the Acute Phase Challenges: Case Series on Prolonged COVID-19 Infection in Immunocompromised Individuals

Kridsanai Gulapa, Dararat Eksombatchai, Tananchai Petnak, Viboon Boonsarngsuk Division of Pulmonary Medicine and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Dararat Eksombatchai, Division of Pulmonary Medicine and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand, Email [email protected]: COVID-19 infection is associated with an increased risk of severe illness and adverse outcomes in individuals with immunocompromising conditions. Immunocompromised patients may have difficulty with viral clearance, which can lead to persistent infection and potential relapses in viral replication.Case Presentation: Herein, we present four cases of persistent COVID-19 pneumonia in immunocompromised patients, including those with diffuse large B-cell lymphoma, polyarteritis nodosa, and end-stage renal disease post-kidney transplant. Three patients had previously received rituximab. Notably, all patients in this cohort demonstrated positive anti-receptor binding-domain immunoglobulin G (IgG) and negative anti-nucleocapsid IgG values.Conclusion: Persistent COVID-19 infection should be considered in the differential diagnosis of immunocompromised patients who exhibit ongoing symptoms or lack of improvement in chest X-ray findings following initial COVID-19 treatment. Early recognition, beyond the diagnosis of post-COVID organizing pneumonia, may significantly improve clinical outcomes with timely and appropriate treatment.Keywords: COVID-19 pneumonia, persistent COVID-19, immunocompromised patients, SAR-CoV-2