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Persistent SARS-CoV-2 Infection in a Multiple Sclerosis Patient on Ocrelizumab: A Case Report

Raghava S Ambadapoodi1, Forest W Arnold2, Julia H Chariker3

  • 1Department of Neurology, University of Chicago Medical Center, Chicago, IL.

Research Square
|April 17, 2023
PubMed

Insights

A patient with multiple sclerosis (MS) on immunosuppressive therapy experienced persistent SARS-CoV-2 pneumonia. This case suggests that B-cell depletion therapy may impair viral clearance, leading to prolonged infections.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Neurology

Background:

  • Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
  • Ocrelizumab is an immunosuppressive monoclonal antibody used for MS treatment, targeting B cells.
  • Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection can cause pneumonia, posing risks to immunocompromised individuals.

Approach:

  • Case study of a 44-year-old female patient with MS treated with ocrelizumab.
  • Analysis of three hospitalizations for SARS-CoV-2 pneumonia over five months.
  • Viral sequencing from initial and final admissions to investigate infection persistence.

Key Points:

  • The patient suffered recurrent SARS-CoV-2 pneumonia despite treatment.
  • Viral sequencing indicated a single, persistent SARS-CoV-2 infection.
  • Immunosuppression from ocrelizumab is hypothesized to impede viral clearance.

Conclusions:

  • Persistent SARS-CoV-2 infection can occur in immunocompromised MS patients.
  • B-cell depletion therapy may compromise the immune system's ability to clear viral infections.
  • This case highlights potential risks associated with immunosuppressive treatments during viral pandemics.
Keywords:
SARS-CoV-2immunocompromisedlong-read sequencingmultiple sclerosisocrelizumabpersistent infection

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