{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:14:26Z","timestamp":1753892066951,"version":"3.41.2"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>This report describes a pediatric patient who underwent chimeric antigen receptor (CAR) T-cell therapy for refractory B-cell acute lymphoblastic leukemia (B-ALL) four years prior, with resultant hypogammaglobulinemia for which he was receiving weekly subcutaneous immune globulin. He presented with persistent fever, dry cough, and a tingling sensation in his toes following a confirmed COVID-19 infection 3 weeks prior. His initial nasopharyngeal SARS-CoV-2 PCR was negative, leading to an extensive workup for other infections. He was ultimately diagnosed with persistent lower respiratory tract COVID-19 infection based on positive SARS-CoV-2 PCR from bronchoalveolar lavage (BAL) sampling. He was treated with a combination of remdesivir (antiviral) and casirivimab\/imdevimab (combination monoclonal antibodies) with immediate improvement in fever, respiratory symptoms, and neurologic symptoms.<\/jats:p>","DOI":"10.3389\/fped.2023.1076686","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T05:11:38Z","timestamp":1678425098000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia"],"prefix":"10.3389","volume":"11","author":[{"given":"Howard","family":"Sanders","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Callas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helaine","family":"St. Amant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong","family":"Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria R.","family":"Dimitriades","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha A.","family":"Nakra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1038\/s41423-021-00774-w","article-title":"Characterization of SARS-CoV-2-specific humoral immunity and its potential applications and therapeutic prospects","volume":"19","author":"Zheng","year":"2021","journal-title":"Cell Mol Immunol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"76","DOI":"10.20411\/pai.v6i1.435","article-title":"COVID-19 Outcomes in patients undergoing B cell depletion therapy and those with humoral immunodeficiency states: a scoping review","volume":"6","author":"Jones","year":"2021","journal-title":"Pathog Immun"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1056\/NEJMoa1407222","article-title":"Chimeric antigen receptor T cells for sustained remissions in leukemia","volume":"371","author":"Maude","year":"2014","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"303ra139","DOI":"10.1126\/scitranslmed.aac5415","article-title":"Chimeric antigen receptor T cells persist and induce sustained remissions in relapsed refractory chronic lymphocytic leukemia","volume":"7","author":"Porter","year":"2015","journal-title":"Sci Transl Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26914","article-title":"Hypogammaglobulinemia due to CAR T-cell therapy","volume":"65","author":"Doan","year":"2018","journal-title":"Pediatr Blood Cancer"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2252","DOI":"10.1093\/cid\/ciaa619","article-title":"To interpret the SARS-CoV-2 test, consider the cycle threshold value","volume":"71","author":"Tom","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/INF.0000000000002660","article-title":"Coronavirus infections in children including COVID-19: an overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children","volume":"39","author":"Zimmermann","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.pcl.2021.05.007","article-title":"Impact of COVID-19 on pediatric immunocompromised patients","volume":"68","author":"Connelly","year":"2021","journal-title":"Pediatr Clin North Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1164\/rccm.202008-3137LE","article-title":"Comparing nasopharyngeal and BAL SARS-CoV-2 assays in respiratory failure","volume":"203","author":"Gao","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1001\/jamapediatrics.2018.2530","article-title":"Long-term survival and value of chimeric antigen receptor T-cell therapy for pediatric patients with relapsed or refractory leukemia","volume":"172","author":"Whittington","year":"2018","journal-title":"JAMA Pediatr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"JCO2200642","DOI":"10.1200\/JCO.22.00642","article-title":"Three-Year update of tisagenlecleucel in pediatric and young adult patients with relapsed\/refractory acute lymphoblastic leukemia in the ELIANA trial","author":"Laetsch","year":"2022","journal-title":"J Clin Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"915590","DOI":"10.3389\/fimmu.2022.915590","article-title":"Comparisons of long-term survival and safety of haploidentical hematopoietic stem cell transplantation after CAR-T cell therapy or chemotherapy in pediatric patients with first relapse of B-cell acute lymphoblastic leukemia based on MRD-guided treatment","volume":"13","author":"Hu","year":"2022","journal-title":"Front Immunol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1182\/blood-2017-07-793760","article-title":"Infectious complications of CD19-targeted chimeric antigen receptor-modified T-cell immunotherapy","volume":"131","author":"Hill","year":"2018","journal-title":"Blood"},{"key":"B14","doi-asserted-by":"publisher","first-page":"ofaa121","DOI":"10.1093\/ofid\/ofaa121","article-title":"Infectious complications following CD19 chimeric antigen receptor T-cell therapy for children, adolescents, and young adults","volume":"7","author":"Vora","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.jaip.2021.10.037","article-title":"Hypogammaglobulinemia after chimeric antigen receptor (CAR) T-cell therapy: characteristics, management, and future directions","volume":"10","author":"Wat","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B16","doi-asserted-by":"publisher","first-page":"796.e1","DOI":"10.1016\/j.jtct.2021.07.005","article-title":"Impact of SARS-CoV-2 in hematopoietic stem cell transplantation and chimeric antigen receptor T cell therapy recipients","volume":"27","author":"Mushtaq","year":"2021","journal-title":"Transplant Cell Ther"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e815","DOI":"10.1093\/cid\/ciab072","article-title":"Intractable coronavirus disease 2019 (COVID-19) and prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in a chimeric antigen receptor-modified T-cell therapy recipient: a case study","volume":"73","author":"Hensley","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1038\/s41586-021-03291-y","article-title":"SARS-CoV-2 evolution during treatment of chronic infection","volume":"592","author":"Kemp","year":"2021","journal-title":"Nature"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3585","DOI":"10.1038\/s41375-021-01466-0","article-title":"Poor outcome of patients with COVID-19 after CAR T-cell therapy for B-cell malignancies: results of a multicenter study on behalf of the European society for blood and marrow transplantation (EBMT) infectious diseases working party and the European hematology association (EHA) lymphoma group","volume":"35","author":"Spanjaart","year":"2021","journal-title":"Leukemia"},{"key":"B20","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1093\/jpids\/piab124","article-title":"Updated guidance on use and prioritization of monoclonal antibody therapy for treatment of COVID-19 in adolescents","volume":"11","author":"Wolf","year":"2022","journal-title":"J Pediatric Infect Dis Soc"},{"key":"B21","doi-asserted-by":"publisher","first-page":"ofac064","DOI":"10.1093\/ofid\/ofac064","article-title":"Combination therapy with casirivimab\/imdevimab and remdesivir for protracted SARS-CoV-2 infection in B-cell-depleted patients","volume":"9","author":"Dioverti","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.ijid.2021.07.064","article-title":"Treatment of SARS-CoV-2 relapse with remdesivir and neutralizing antibodies cocktail in a patient with X-linked agammaglobulinaemia","volume":"110","author":"Palomba","year":"2021","journal-title":"Int J Infect Dis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.ijid.2021.07.066","article-title":"Spectrum of acute neuropathy associated with COVID-19: a clinical and electrophysiological study of 13 patients from a single center","volume":"110","author":"Yaranagula","year":"2021","journal-title":"Int J Infect Dis"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1076686\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T05:11:41Z","timestamp":1678425101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1076686\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,10]]},"references-count":23,"alternative-id":["10.3389\/fped.2023.1076686"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1076686","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2023,3,10]]},"article-number":"1076686"}}