Convalescent plasma therapy in a refractory case of COVID-19 in an immunocompromised patient

ABSTRACT

INTRODUCTION: Convalescent plasma therapy (CPT) is a relatively new treatment option offered for COVID 19 pneumonia. Both the side effects and disease course after treatment with CPT have not been thoroughly investigated. CPT is primarily reserved for those participating in FDA approved clinical trials, however this case highlights an immunocompromised patient who benefited from CPT although was excluded from the clinical trial. METHODS: A 60-year-old female with a past medical history of rheumatoid arthritis (RA) was admitted for COVID 19 pneumonia on 6/18/2020. Her current management of her RA included Rituximab infusions which she received most recently one week prior to admission. On presentation she was noted to be febrile and in hypoxic respiratory failure requiring HFNC for oxygen support. She was treated with a 5-day course of dexamethasone and Remdesivir during her hospitalization. She initially had a great clinical response and was afebrile and weaned off of supplemental oxygen by the time of discharge. Patient was re-admitted three weeks later with fevers and SOB. COVID swab remained positive and coronavirus antibodies were negative. Patient was admitted to the ICU for high oxygen O2 requirements and required intubation. Bronchoscipt with alveolar lavage was performed which revealed no bacterial or fungal source of infection. Due to continued elevation of inflammatory markers, oxygen requirement and clinical symptoms, the patient was started on a second course of Remdesivir which was extended to 10 days. The patient was approved for CPT and received transfusion two weeks after admission with no adverse effects. Patient was discharged on room air 4 days after treatment and inflammatory markers markedly trended down. Her repeat COVID swab prior to discharge was negative. RESULTS: Research surrounding CPT in immunocompromised patients infected with COVID-19 is limited. With no vaccine available, CPT has been shown to be beneficial with clearance of viral load. Our case demonstrated the successful use of CPT in an immunocompromised individual. Further research needs to be done to evaluate the effectiveness of CPT in immunocompromised patients infected with COVID 19.