[Recurrent COVID-19 in a patient with Good's syndrome: a case report and literature review].

Y L Yang, T Zhang
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引用次数: 0

Abstract

We herein report a case of recurrent coronavirus disease 2019 (COVID-19) in a 56-year-old female with Good's syndrome (GS) at Peking Union Medical College Hospital in April 2024. The patient was previously treated with thymectomy for thymoma and her immunoglobulin assays and lymphocyte subset analysis confirmed an immunocompromised state characterized predominantly by humoral immunodeficiency, consistent with a diagnosis of GS. Clinical symptoms improved following two courses of nirmatrelvir/ritonavir and four courses of molnupiravir, administered alongside adjunctive glucocorticoids and regular intravenous immunoglobulin (IVIG) supplementation. By the end of August 2024, a review of the literature identified 40 reported cases of COVID-19 in patients with GS worldwide. Among them, 25 met the diagnostic criteria for severe or critical illness, and 12 experienced persistent or relapsing infections. Antiviral therapy was administered in approximately half of the cases, most commonly for a 5-day course. However, four patients required prolonged or multi-target antiviral regimens due to persistent or relapsing infection, with the longest duration reported at 20 days. Convalescent plasma or monoclonal antibodies were used in 15 patients, and adjunctive glucocorticoids in 13. The vast majority received regular IVIG supplementation. Ten patients (25%) with GS and COVID-19 died. Patients with GS are susceptible to prolonged or recurrent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and are at increased risk of severe disease and mortality due to impaired antibody production. Upon diagnosis of GS, IVIG therapy should be initiated. In the context of COVID-19, potential treatment strategies include extended multi-agent antiviral therapy guided by viral load, use of convalescent plasma (where available), and glucocorticoids tailored to disease severity. Further research is needed to define the optimal duration and combination of antiviral and immunomodulatory therapies in this population.

【Good’s综合征患者复发性COVID-19 1例报告及文献复习】。
我们报告一例复发性冠状病毒病2019 (COVID-19)于2024年4月在北京协和医院就诊的56岁女性古德综合征(GS)患者。该患者此前曾因胸腺瘤接受胸腺切除术治疗,其免疫球蛋白检测和淋巴细胞亚群分析证实了以体液免疫缺陷为主要特征的免疫功能低下状态,与GS的诊断一致。两个疗程的尼马特利韦/利托那韦和四个疗程的莫努匹拉韦与辅助糖皮质激素和定期静脉注射免疫球蛋白(IVIG)一起使用后,临床症状得到改善。截至2024年8月底,一项文献综述在全球GS患者中发现了40例报告的COVID-19病例。其中符合重症、危重症诊断标准的25例,持续或复发感染的12例。大约一半的病例接受了抗病毒治疗,最常见的是5天疗程。然而,由于持续或复发感染,4例患者需要延长或多靶点抗病毒治疗方案,最长持续时间为20天。恢复期血浆或单克隆抗体15例,辅助糖皮质激素13例。绝大多数人定期补充IVIG。GS合并COVID-19患者死亡10例(25%)。GS患者容易长期或反复感染严重急性呼吸综合征冠状病毒2 (SARS-CoV-2),并且由于抗体产生受损,严重疾病和死亡的风险增加。一旦诊断为GS,应开始IVIG治疗。在COVID-19的背景下,潜在的治疗策略包括根据病毒载量指导延长多药抗病毒治疗,使用恢复期血浆(如有)和根据疾病严重程度量身定制的糖皮质激素。在这一人群中,需要进一步的研究来确定抗病毒和免疫调节治疗的最佳持续时间和组合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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