{"doi":"10.31219/osf.io/bmhse","title":"Prolonged SARS-CoV-2 infection CART","abstract":"Background: Patients with B-cell aplasia, such as recipients of CAR-T-cell therapy forhematological malignancies, may be at risk for protracted SARS-CoV-2 replication and chronicshedding of infectious virus.Methods: A man in his 70’s who had undergone CAR-T-cell therapy presented with COVID-19pneumonia and improved after receipt of convalescent plasma and remdesivir. He wasdischarged on room air but returned on day 41 after COVID-19 diagnosis with progressiveradiographic abnormalities and persistent detection of SARS-CoV-2 RNA from nasopharyngealswabs. He died due to progressive respiratory failure on day 74 of illness. Plasma andendotracheal aspirate (ETA) samples were collected for viral quantification, viral titration andculture, and immunological assays.Findings: The patient had high-grade SARS-CoV-2 RNAemia in plasma collected on days 4, 9,13, 16, and 71. RNAemia peaked at >105 copies/ml, declined after administration of remdesivirand convalescent plasma (104 copies/ml), but subsequently rebounded to >105 copies/ml beforedeath. On day 72, ETA showed 2.78x1010 copies/mL of SARS-CoV-2 RNA, high-titer infectiousvirus (1.125x106 plaque-forming units/mL) that was successfully cultured, and numerous virusparticles by electron microscopy. Serologic assays showed minimal to no antibody to SARSCoV-2, and B-cells were not detected by immunophenotyping or by single-cell RNAseq.Interpretation: This case provides new insights into the potential prolonged duration and extentof viral replication without appropriate humoral immune responses. This case also challengesthe belief that persistent detection of SARS-CoV-2 RNA in respiratory secretions representsshedding of non-infectious RNA, which should prompt re-evaluation of infection preventionguidelines in immunosuppressed hosts.","journal":"OSF Preprints (OSF Preprints)","year":2020,"id":134623,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9603,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":536897,"name":"Ghady Haidar","orcid":"0000-0003-0634-8211","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-18T23:16:24.540681Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}