Persistent SARS-CoV-2 Infection in a Patient with Nephrotic Syndrome under Rituximab Therapy: Successful Treatment with a Combination of Remdesivir and Monoclonal Antibodies

Akihiro Shimizu; Izumi Shirai; Kyohei Ogawa; Akane Miura; Kotaro Haruhara; Kentaro Oshiro; Akihiko Hamaguchi; Shinya Yokote; Masahiro Okabe; Hiroyuki Ueda; Nobuo Tsuboi; Masato Ikeda; Takashi Yokoo

doi:10.2169/internalmedicine.0241-22

CASE REPORTS

Persistent SARS-CoV-2 Infection in a Patient with Nephrotic Syndrome under Rituximab Therapy: Successful Treatment with a Combination of Remdesivir and Monoclonal Antibodies

Akihiro Shimizu, Izumi Shirai, Kyohei Ogawa, Akane Miura, Kotaro Haruhara, Kentaro Oshiro, Akihiko Hamaguchi, Shinya Yokote, Masahiro Okabe, Hiroyuki Ueda, Nobuo Tsuboi, Masato Ikeda, Takashi Yokoo

Author information

Akihiro Shimizu
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Izumi Shirai
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Kyohei Ogawa
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Akane Miura
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Kotaro Haruhara
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Kentaro Oshiro
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Akihiko Hamaguchi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Shinya Yokote
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Katsushika Medical Center, Japan
Masahiro Okabe
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Daisan Hospital, Japan
Hiroyuki Ueda
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Nobuo Tsuboi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Masato Ikeda
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Japan
Takashi Yokoo
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan

Keywords: minimal change disease, frequently relapsing/steroid-dependent nephrotic syndrome, rituximab, REGEN-COV, monoclonal antibody therapy, COVID-19

JOURNAL OPEN ACCESS

2022 Volume 61 Issue 24 Pages 3703-3708

DOI https://doi.org/10.2169/internalmedicine.0241-22

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Abstract

Rituximab is an effective treatment for frequently relapsing/steroid-dependent nephrotic syndrome, but there is concern about infections caused by humoral immunodeficiency. We herein report a case of prolonged (>7 weeks) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old man with minimal change disease treated with rituximab developed SARS-CoV-2 infection. The clinical response to remdesivir was soon transiently abolished. Treatment with casirivimab and imdevimab (REGEN-COV) monoclonal antibodies in combination with remdesivir resulted in complete clearance of the infection. The REGEN-COV antibody cocktail may improve the outcome of SARS-CoV-2 infection in patients with humoral immunodeficiency.

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