{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T08:19:02Z","timestamp":1761812342004,"version":"build-2065373602"},"reference-count":25,"publisher":"Wiley","issue":"20","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017964","name":"Tianjin Municipal Health Commission","doi-asserted-by":"publisher","award":["TJWJ2023ZD003"],"award-info":[{"award-number":["TJWJ2023ZD003"]}],"id":[{"id":"10.13039\/100017964","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018904","name":"Beijing Xisike Clinical Oncology Research Foundation","doi-asserted-by":"publisher","award":["Y\u2010NCJH202201\u20100027","Y\u20102022YMJN\/MS\u20100001"],"award-info":[{"award-number":["Y\u2010NCJH202201\u20100027","Y\u20102022YMJN\/MS\u20100001"]}],"id":[{"id":"10.13039\/100018904","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hematologic malignancy patients with B lymphocytopenia after anti\u2010CD20 monoclonal antibody or anti\u2010CD19 chimeric antigen receptor (CAR) T cell therapy often face prolonged SARS\u2010CoV\u20102 positivity on pharyngeal swabs and persistent or recurrent COVID\u201019 infection, resulting in high mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Here, we describe three follicular lymphoma (FL) patients with persistent fever, cough, and hypoxemia, but they were ruled out for bacterial, viral, fungal, and other pathogen infections, and the throat swabs were consistently SARS\u2010CoV\u20102 negative. These FL patients with B lymphocyte deficiency who were diagnosed with COVID\u201019 infection confirmed by bronchoalveolar lavage fluid (BALF) metagenomics next\u2010generation sequencing (mNGS). Their COVID\u201019 infection was characterized by differences in viral load in the upper and lower respiratory tracts. When this particular COVID\u201019 infection occurred, although their percentages and absolute values of CD8\n                      <jats:sup>+<\/jats:sup>\n                      T cells and CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cells were normal, they all had B lymphocyte deficiency and hypogammaglobulinemia. They all had low expression of interleukin (IL)\u20106 in peripheral blood inconsistent with clinical infection symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patients received a combination therapy of molnupiravir and methylprednisolone; then their symptoms were relieved over the next 2\u2009weeks\u20132\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Therefore, for immunocompromised patients, especially those with B lymphocyte deficiency, hypogammaglobulinemia, and low expression of IL\u20106 in peripheral blood inconsistent with clinical infection symptoms, mNGS for BALF should be performed as soon as possible in this particular condition to confirm the diagnosis of COVID\u201019 infection.<\/jats:p>\n                  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