Severe relapse of SARS-CoV-2 infection in a kidney transplant recipient with negative nasopharyngeal SARS-CoV-2 RT-PCR after rituximab

Antoine Morel (1, 2) , Sandrine Imbeaud (3) , Anne Scemla (4, 5) , Hélène Péré (3) , Jacques Fourgeaud (6) , Lucile Amrouche (1, 7) , Nicolas Robillard (8) , Delphine Planas (9, 10) , Julien Puech (8) , Sylvie Simon (8) , Fanny Lanternier (1, 7) , Laurent Bélec (8, 11) , Julien Zuber (12, 1) , Olivier Schwartz (9, 10) , Dany Anglicheau (1, 12) , Nathalie Chavarot (13, 1) , David Veyer (14, 3)

1 Hôpital Necker - Enfants Malades [AP-HP]
2 Université Paris-Saclay
3 FunGeST - Génomique fonctionnelle des tumeurs solides = Functional Genomics of Solid Tumors [CRC]
4 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
5 USPC - Université Sorbonne Paris Cité
6 Laboratoire de Virologie [CHU Necker]
7 UPD5 - Université Paris Descartes - Paris 5
8 HEGP - Hôpital Européen Georges Pompidou [APHP]
9 CNRS-UMR3569 - Virus et Immunité - Virus and immunity
10 VRI - Vaccine Research Institute [Créteil, France]
11 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
12 UPCité - Université Paris Cité
13 UPD7 - Université Paris Diderot - Paris 7
14 Laboratoire de Virologie [Hôpital Européen Georges Pompidou - APHP]

Immunocompromised patients may experience prolonged viral shedding after their initial SARS-CoV-2 infection, however, symptomatic relapses after remission currently remain rare. We herein describe a severe COVID-19 relapse case of a kidney transplant recipient (KTR) following rituximab therapy, 3 months after a moderate COVID-19 infection, despite viral clearance after recovery of the first episode. During the clinical relapse, the diagnosis was established on a broncho-alveolar lavage specimen (BAL) by RT-PCR. The infectivity of the BAL sample was confirmed on a cell culture assay. Whole genome sequencing confirmed the presence of an identical stain (Clade 20A). However, it had an acquired G142D mutation and a larger deletion of 3-amino-acids at position 143-145. These mutations located within the N-terminal domain are suggested to play a role in viral entry. The diagnosis of a COVID-19 relapse should be considered in the setting of unexplained persistent fever and/or respiratory symptoms in KTRs (especially for those after rituximab therapy), even in patients with previous negative naso-pharyngeal SARS-CoV-2 PCR.

Mots clés: clinical research/practice; infection and infectious agents-viral; infectious disease; kidney transplantation/nephrology; lung disease: infectious; translational research/science

Domaines: Sciences du Vivant [q-bio]

Antoine Morel, Sandrine Imbeaud, Anne Scemla, Hélène Péré, Jacques Fourgeaud, et al.. Severe relapse of SARS-CoV-2 infection in a kidney transplant recipient with negative nasopharyngeal SARS-CoV-2 RT-PCR after rituximab. American Journal of Transplantation, 2022, 22 (8), pp.2099-2103. ⟨10.1111/ajt.17000⟩. ⟨hal-04147995⟩