Persistent SARS-CoV-2 Beta Variant Infection in Patients with Follicular Lymphoma

Paweł Radkowski, Kamil Sobolewski, Hubert Oniszczuk, Justyna Opolska, Bartosz Kędziora, Anna Witt-Majchrzak, Radosław Borysiuk and Łukasz Grabarczyk

Background and Objective: Immunosuppressed patients with COVID-19 can experience prolonged viral shedding, allowing SARS-CoV-2 to evolve into multiple mutational variants due to the lack of immune pressure and antiviral treatments. However, no standardized treatment protocol exists for managing such cases. This study investigates treatment strategies for persistent COVID-19 in immunosuppressed patients by reviewing existing literature and analyzing a clinical case. Materials and Methods: The study focuses on a 48-year-old woman with follicular lymphoma (FL) who experienced multiple COVID-19 episodes despite prior treatments. The patient was treated with a 10-day intravenous remdesivir regimen, oxygen therapy and trimethoprim/sulfamethoxazole prophylaxis while undergoing genomic monitoring. Clinical evaluation included CT scans, chest X-rays, RT-PCR tests and genomic sequencing to track viral mutations. No statistical tests were applied, but the study provides a detailed clinical assessment of disease progression and treatment response. Results: The combination of remdesivir, oxygen therapy and antibiotics successfully improved the patient’s condition, leading to a non-oxygen-dependent SpO₂ of 94% by discharge. Genomic sequencing identified the B.1.177 variant, carrying multiple spike protein mutations, suggesting immune escape mechanisms. Despite an initial negative antigen test after 16 days, the patient remained SARS-CoV-2 positive in subsequent tests, emphasizing the virus’s adaptability in immunosuppressed hosts. The study highlights the importance of genomic monitoring in optimizing treatment strategies. Conclusion: This case study demonstrates the effectiveness of remdesivir, oxygen therapy and antibiotic prophylaxis in treating persistent COVID-19 in immunosuppressed patients. However, the findings are limited by the single-patient analysis, lack of control groups and absence of long-term follow-up. Future research should focus on larger cohorts and randomized controlled trials to evaluate antiviral and immune-modulatory therapies. Genomic surveillance should also be prioritized to understand viral evolution and its impact on treatment outcomes.

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