Emerging RNA-Dependent RNA Polymerase Mutation in a Remdesivir-Treated B-cell Immunodeficient Patient With Protracted Coronavirus Disease 2019

Martin Martinot; Aude Jary; Samira Fafi-Kremer; Valentin Leducq; Heloise Delagreverie; Marc Garnier; Jérôme Pacanowski; Arsène Mékinian; France Pirenne; Pierre Tiberghien; Vincent Calvez; Catherine Humbrecht; Anne-Geneviève Marcelin; Karine Lacombe

doi:10.1093/cid/ciaa1474

Emerging RNA-Dependent RNA Polymerase Mutation in a Remdesivir-Treated B-cell Immunodeficient Patient With Protracted Coronavirus Disease 2019

Clin Infect Dis. 2021 Oct 5;73(7):e1762-e1765. doi: 10.1093/cid/ciaa1474.

Authors

Martin Martinot¹, Aude Jary², Samira Fafi-Kremer^{3

4}, Valentin Leducq², Heloise Delagreverie^{3

4}, Marc Garnier⁵, Jérôme Pacanowski⁶, Arsène Mékinian⁷, France Pirenne^{8

9}, Pierre Tiberghien^{8

10}, Vincent Calvez², Catherine Humbrecht¹¹, Anne-Geneviève Marcelin², Karine Lacombe¹²

Affiliations

¹ Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France.
² Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, Paris, France.
³ Virology Laboratory, Strasbourg University Hospital, Strasbourg, France.
⁴ Strasbourg University, INSERM, IRM UMR-S 1109, F-67000 Strasbourg, France.
⁵ Sorbonne Université, GRC 29, APHP, DMU DREAM, Anesthesiology and Intensive Care Department, Saint-Antoine Hospital, Paris, France.
⁶ Infectious Diseases Department, Saint-Antoine Hospital, APHP - Sorbonne Université, Paris, France.
⁷ Sorbonne Université, Internal Medicine Department, Inflammation-Immunopathology-Biotherapy Department (DMU i3D), Saint-Antoine Hospital, AP-HP, Paris, France.
⁸ Etablissement Français du Sang, La Plaine St-Denis - France.
⁹ Institut Mondor de Recherche Biomédicale, Unité 955, Equipe 2: Transfusion et Maladies du Globule Rouge, INSERM, EFS, Université Paris-Est Créteil, Créteil, France.
¹⁰ UMR 1098 RIGHT Inserm Université de Franche-Comté Etablissement Français du Sang, Besançon.
¹¹ Etablissement Français du sang Grand Est, Strasbourg, France.
¹² Sorbonne Université, Inserm IPLESP, Infectious Diseases Department, Saint-Antoine Hospital, APHP, Paris, France.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered virus for which remdesivir is the only antiviral available. We report the occurrence of a mutation in RdRP (D484Y) following treatment with remdesivir in a 76-year-old female with post-rituximab B-cell immunodeficiency and persistent SARS-CoV-2 viremia. A cure was achieved after supplementation with convalescent plasma.

Keywords: COVID-19; RNA-dependent RNA-polymerase mutation; SARS-CoV-2; convalescent plasma; remdesivir.

Publication types

Case Reports

MeSH terms

Adenosine Monophosphate / analogs & derivatives
Aged
Alanine / analogs & derivatives
B-Lymphocytes
COVID-19* / drug therapy
COVID-19* / therapy
Female
Humans
Immunization, Passive
Mutation
RNA-Dependent RNA Polymerase*
SARS-CoV-2

Substances

remdesivir
Adenosine Monophosphate
RNA-Dependent RNA Polymerase
Alanine

Supplementary concepts

COVID-19 drug treatment
COVID-19 serotherapy