Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports

Int J Med Sci. 2020 Oct 18;17(18):2974-2986. doi: 10.7150/ijms.50537. eCollection 2020.


In the ongoing COVID-19 pandemic, all COVID-19 patients are naïve patients as it is the first-time humans have been exposed to the SARS-CoV-2 virus. As with exposure to many viruses, individuals with pre-existing, compromised immune systems may be at increased risk of developing severe symptoms and/or dying because of (SARS-CoV-2) infection. To learn more about such individuals, we conducted a search and review of published reports on the clinical characteristics and outcomes of COVID-19 patients with pre-existing, compromised immune systems. Here we present our review of patients who possess pre-existing primary antibody deficiency (PAD) and those who are organ transplant recipients on maintenance immunosuppressants. Our review indicates different clinical outcomes for the patients with pre-existing PAD, depending on the underlying causes. For organ transplant recipients, drug-induced immune suppression alone does not appear to enhance COVID-19 mortality risk - rather, advanced age, comorbidities, and the development of secondary complications appears required.

Publication types

  • Review

MeSH terms

  • Betacoronavirus / immunology
  • Betacoronavirus / physiology
  • COVID-19
  • Comorbidity
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / immunology
  • Humans
  • Immune System Diseases / complications*
  • Immune System Diseases / diagnosis*
  • Immunocompromised Host* / immunology
  • Immunosuppressive Agents / therapeutic use
  • Mortality
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / immunology
  • Primary Immunodeficiency Diseases / complications
  • Primary Immunodeficiency Diseases / diagnosis
  • Primary Immunodeficiency Diseases / immunology
  • Primary Immunodeficiency Diseases / mortality
  • Prognosis
  • SARS-CoV-2
  • Transplant Recipients / statistics & numerical data


  • Immunosuppressive Agents