Sex: M
Vaccine: COVID19
Symptoms: Bronchoalveolar lavage, Bronchoscopy, COVID-19, Chest X-ray, Computerised tomogram thorax
Clinical narrative: positive polymerase chain reaction (PCR) results for SARS-CoV-2; positive polymerase chain reaction (PCR) results for SARS-CoV-2; This is a literature report for the following literature source(s).  A 34-year-old male patient received BNT162b2 (BNT162B2), as dose 1, single (Batch/Lot number: unknown), as dose 2, single (Batch/Lot number: unknown) and as dose 3 (booster), single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "Philadelphia-negative chromosome B-cell acute lymphoblastic leukemia" (unspecified if ongoing); "Philadelphia-negative chromosome B-cell acute lymphoblastic leukemia" (unspecified if ongoing). The patient's concomitant medications were not reported. The following information was reported: DRUG INEFFECTIVE (medically significant, life threatening), COVID-19 (medically significant, life threatening) all with onset Feb2022, outcome "recovered" and all described as "positive polymerase chain reaction (PCR) results for SARS-CoV-2". The event "positive polymerase chain reaction (pcr) results for sars-cov-2" required emergency room visit. The patient underwent the following laboratory tests and procedures: Bronchoalveolar lavage: (2022) SARS-CoV-2 was detected; Bronchoscopy: (2022) SARS-CoV-2 was detected in a bronchoalveolar lavag, notes: sample with PCR, with a cycle threshold of 30, despite negative nasal swab sample. No other pathogens were identified. Sequence analysis from several samples confirmed BA.1.1 lineage with mutations associated with sotrovimab resistance; Chest X-ray: (2022) basilar atelectasis, notes: On day 19; (2022) patchy bibasilar opacities; Computerised tomogram thorax: (2022) new patchy bilateral, notes: ground-glass opacification; (2022) demonstrated some areas of improvement, notes: but multiple new ground-glass opacities on day 156; Gene sequencing: (2022) confirmed BA.1.1 lineage, notes: ith mutations associated with sotrovimab resistance; Nasopharyngeal swab: (2022) negative, notes: On days 92; (2022) negative, notes: On days 100; (2022) negative; (2022) remained negative; Oxygenation index: (2022) normal, notes: On day 19; Philadelphia chromosome test: (2022) negative; Polymerase chain reaction: (2022) negative, notes: On days 92; (2022) negative, notes: On days 100; (2022) negative; (2022) remained negative; (2022) positive, notes: for SARS-CoV-2; (2022) SARS-CoV-2 was detected, notes: in a bronchoalveolar lavage fluid sample with a cycle threshold of 30; SARS-CoV-2 test: (Feb2022) SARS-CoV-2 infection; Viral test: (Feb2022) persistent. Therapeutic measures were taken as a result of drug ineffective, covid-19.  Clinical course: A 34-year-old man with Philadelphia-negative chromosome B-cell acute lymphoblastic leukemia in remission on vincristine and rituximab maintenance chemotherapy, who had previously received 3 doses of Pfizer messenger RNA (mRNA) vaccine, had SARS-CoV-2 infection diagnosed in February 2022. He received intravenous sotrovimab on day 1 after diagnosis but had no improvement in symptoms. On day 19, he presented to the emergency department with shortness of breath, cough, and post tussive emesis. His oxygenation was normal, and chest radiography showed basilar atelectasis, for which he was prescribed azithromycin and discharged to home. His symptoms persisted, along with positive polymerase chain reaction (PCR) results for SARS-CoV-2. On day 85, the patient presented to the emergency department with cough affecting his ability to work. He had persistent viral detection, and chest radiography showed patchy bibasilar opacities. He was sent home on antibiotics. On days 92 and 100, PCR tests of nasal swab samples had negative results, but chest computed tomography (CT) showed new patchy bilateral ground-glass opacification, for which the patient received another course of antibiotics. His symptoms persisted, and repeated chest CT on day 156 demonstrated some areas of improvement but multiple new ground-glass opacities. Bronchoscopy was performed to distinguish between viral lower respiratory tract infection organizing pneumonia, or another contributing condition, and SARS-CoV-2 was detected in a bronchoalveolar lavage fluid sample with PCR, with a cycle threshold of 30, despite negative nasal swab sample. No other pathogens were identified. Sequence analysis from several samples confirmed BA.1.1 lineage with mutations associated with sotrovimab resistance. The patient started treatment with nirmatrelvir-ritonavir as an eIND on day 170. On day 6 of therapy, his cough was improving, though still present, and the treatment was continued. After 15 days his cough was nearly resolved, he had returned to full activity, and therapy was discontinued. PCR results with nasal swab samples remained negative. The patient reported no adverse drug effects, and 1 month after completing treatment, he remained asymptomatic.; Sender's Comments: A possible contributory role of the suspect products cannot be excluded for the reported event based on the known safety profile and temporal association.