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.


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 Treatment*
  • COVID-19 Serotherapy
  • COVID-19* / therapy
  • Female
  • Humans
  • Immunization, Passive
  • Mutation
  • RNA-Dependent RNA Polymerase*
  • SARS-CoV-2


  • remdesivir
  • Adenosine Monophosphate
  • RNA-Dependent RNA Polymerase
  • Alanine