Persistent SARS-CoV-2 RNA Positivity in a Chronic Lymphocytic Leukaemia Patient for 127 Days After Disease Onset: A Case Report.

Abstract

Chronic lymphocytic leukaemia (CLL) is characterised by profound immune dysfunction, increasing susceptibility to severe and persistent infections such as COVID-19. Our case report presents a 69-year-old woman with CLL who exhibited a prolonged duration of SARS-CoV-2 RT-PCR positivity-127 days-despite receiving standard therapies including dexamethasone and remdesivir. The patient, previously on maintenance ibrutinib, presented with fever and ground-glass opacities on CT scan and laboratory findings revealed marked lymphocytosis, elevated inflammatory markers and hepatic and renal dysfunction. Persistent viral shedding was attributed to CLL-associated hypogammaglobulinemia and chemotherapy-induced immunosuppression, resulting in impaired antibody response and eventual fatal hypoxemia. This case underscores the challenges of managing COVID-19 in CLL patients and highlights the need for individualised treatment strategies, including consideration of monoclonal antibodies and immunoglobulin replacement, to address prolonged viral replication and improve clinical outcomes in this vulnerable population.