Remdesivir-resistant version of COVID-19 detected in organ transplant recipients nyulangone
While measures to curb the spread of SARS-CoV-2, a pathogen that has claimed the lives of more than a million Americans, continue to ease in many parts of the United States, the risk of adverse outcomes related to infection in immunocompromised hosts remains substantial. In a recent meta-analysis that included nearly 12,000 solid organ transplant recipients, vaccination against COVID-19 elicited a humoral response that was significantly reduced compared to that of immunocompetent hosts.
Six months after transplant, the patient developed the new onset of malaise, fatigue, cough, and fever. On admission, nasopharyngeal RT-PCR was positive for SARS-CoV-2 with a cycle threshold of 27.1. Genomic sequencing identified the B.1.529 subvariant BA.1.1. Not requiring oxygen at that time, the patient received a five-day course of remdesivir, experienced improvement in symptomatology including defervescence, and was discharged.
24 days after the diagnosis of COVID-19, the patient was readmitted with worsening fatigue, cough, dyspnea, abdominal discomfort, and fever. Nasopharyngeal SARS-CoV-2 RT-PCR was again positive with a Ct of 24.4, and genomic sequencing identified Omicron BA.1.1. In the setting of a substantial oxygen requirement, the patient was treated with another five-day course of remdesivir and a ten-day course of dexamethasone.
110 days after COVID-19 diagnosis, the patient developed a new onset of dry cough and rhinorrhea. Nasopharyngeal RT-PCR was positive for SARS-CoV-2 with a Ct of 23.3 . RT-PCR for other respiratory pathogens was negative. Repeat RT-PCR one week later yielded a Ct of 22.6, and genomic sequencing at that time identified asynonymous mutation in RdRp at K890 . Providers monitored the patient’s mild symptoms, which gradually improved over the course of weeks.
Fourteen months after transplant, the patient developed malaise, shortness of breath, and cough. Nasopharyngeal PCR was positive for SARS-CoV-2, and in the setting of pulmonary infiltrates on x-ray and hypoxemia, the patient received a three-day course of remdesivir and a four-day course of baricitinib. SARS-CoV-2 genomic sequencing performed on day seven of illness identified aV792I mutation in RdRp .
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