Sex: M
Vaccine: COVID19, COVID19
Symptoms: Biopsy, Blood fibrinogen, Bronchoscopy, COVID-19, Computerised tomogram
Clinical narrative: CONFIRMED COVID-19 INFECTION; POSSIBLE POST-COVID ORGANIZING PNEUMONIA; This spontaneous report was received from literature: Journal of Respiratory and Critical Care Medicine 2022 205 no pagination. This report concerned a 47 year old male of an unspecified race and ethnicity. Initial information was processed along with the additional information received on 22-JUL2022. The objective of the study is to describe, Protracted COVID-19 Infection After Rituximab Therapy, Rituximab, a monoclonal antibody against the CD-20 molecule, is essential to the treatment of hematologic malignancies. Because it works through depletion of plasma cells, it impairs the immune response to both pathogens and vaccinations. With regards to COVID-19, a lack of antibody response to vaccination as well as prolonged illness have been demonstrated after rituximab therapy. The patient's height, and weight were not reported. The patient's concurrent conditions included: chronic lymphocytic leukemia, and small lymphocytic lymphoma. The patient received covid-19 vaccine ad26.cov2.s (dose number in series:1) (suspension for injection, route of admin, batch number and expiry were not reported) dose was not reported, 1 total administered on 27-MAR-2021 for covid-19 prophylaxis. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included cyclophosphamide/fludarabine/rituximab for chronic lymphocytic leukemia, and small lymphocytic lymphoma, and rituximab/venetoclax for chronic lymphocytic leukemia, and small lymphocytic lymphoma. Two weeks after the vaccination on APR-2021, patient tested positive for COVID 19 and was symptomatic with fevers, dyspnea eventually hypoxia (Confirmed covid-19 infection) (dose number in series:1). Over the next 2 months the patient had multiple hospitalizations with persistent symptoms, persistently COVID PCR positive, with cycle count reaching 26 (indeterminate viral load, high viral load being 2000, fibrinogen>700. Hemophagocytic lymphohistiocytosis (HLH) was considered but bone marrow biopsy was not consistent with HLH. Several subsequent CT scans showed waxing and waning peripheral migratory ground glass infiltrates. He was started on high dose prednisone (1 mg/kg) 12 weeks after initial infection to treat possible post-COVID organizing pneumonia. At 16 weeks he was readmitted to the hospital with relapse in symptoms. At this point, VATS (Video-assisted thoracoscopic surgery) and biopsy were performed. Pathology results showed acute lung injury and diffuse alveolar damage with diffuse lymphocytic infiltration consistent with ongoing viral infection (dose number in series 1). The number of days of hospitalization was not reported and it was unsure if the patient was discharged from the hospital. On an unspecified date in 2021 after 22 weeks of vaccination, The patient received, non-company suspect vaccine elasomeran (Moderna) (dose number in series: 2) ( form of admin, route of admin, batch number and expiry were not reported) dose was not reported, administered on 2021 for covid-19 prophylaxis.  It was unknown whether patient had any adverse events following covid-19 vaccine elasomeran (Moderna) (dose number in series: 2). The action taken with covid-19 vaccine ad26.cov2.s, and elasomeran was not applicable. The authors concluded that e protracted course of COVID-19 illness in a patients treated with rituximab. Given plasma cell depletion and inability to mount a humoral response, there can be difficulty resolving the infection. Rather than a fulminant inflammatory respiratory failure. The outcome of the confirmed covid-19 infection and possible post-covid organizing pneumonia was not reported. This report was serious (Hospitalization Caused / Prolonged). This report was associated with a product quality complaint: 90000243209.; Sender's Comments: V0: 20220742438-covid-19 vaccine ad26.cov2.s-Confirmed COVID-19 infection. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). Therefore, this event(s) is considered unassessable. 20220742438-covid-19 vaccine ad26.cov2.s- Possible post-covid organizing pneumonia . The case causality is considered NOT RELATED. Rationale: The concurrent COVID-19 Infection in presence of immunocompromised state provides more plausible explanation for the event than the role of vaccine.