Характерно, что попытки лечить пневмонию кортикостероидами к успеху не привели, а только к ухудшению состояния и активации инфекции, так что в конце концов ее пролечили высокими уровнями антител и ремдесивиром, и вроде бы вылечили, в итоге. Ну не то чтоб совсем вылечили (просто стало чуть полегче, уже в покое можно обойтись без кислородной поддержки, и легкие чуть попрозрачнели), но вирус не выделяется.
B-cell depleting therapies may lead to protracted disease and prolonged viral shedding in individuals infected with SARS-CoV-2. Viral persistence in the setting of immunosuppression raises concern for viral evolution. Methods: Amplification of sub-genomic transcripts for the E gene (sgE) was done on nasopharyngeal samples over the course of 355 days in a patient infected with SARS-CoV-2 who had previously undergone CAR T cell therapy and had persistently positive SARS-CoV-2 nasopharyngeal swabs. Whole genome sequencing was performed on samples from the patients original presentation and 10 months later. Results: Over the course of almost a year, the virus accumulated a unique in-frame deletion in the amino-terminal domain of the spike protein, and complete deletion of ORF7b and ORF8, the first report of its kind in an immunocompromised patient. Also, minority variants that were identified in the early samples reflecting the heterogeneity of the initial infection were found to be fixed late in the infection. Remdesivir and high-titer convalescent plasma treatment were given, and the infection was eventually cleared after 335 days of infection. Conclusions: The unique viral mutations found in this study highlight the importance of analyzing viral evolution in protracted SARS-CoV-2 infection, especially in immunosuppressed hosts, and the implication of these mutations in the emergence of viral variants. It is possible that the immunocompromised nature of this patient removes a need for ORF8 during infection.This hypothesis is supported by data that show ORF8 is particularly tolerant to mutation, acquiring many missense and nonsense mutations. ORF8 was also shown to be dispensable in cell culture This case demonstrates that severely immunocompromised patients may experience protracted SARS-CoV-2 infection with mild symptoms and persistent virus replication. Our case also highlights the limitations of SARS-CoV-2 testing, especially for lower respiratory tract disease, as access to a BAL specimen may have alerted us earlier to ongoing infection. Further research is necessaryto understand the evolution of SARS-CoV-2 in immunocompromised hosts, especially in relation to implications for viral transmission and variant emergence.