A 69-year-old woman with chronic lymphocytic leukaemia carried SARS-CoV-2 RNA in her nasopharyngeal tract for 127 days in a fatal case documented in Respirology Case Reports. Published by clinicians in 2026, the report reveals how profound immunodeficiency allows continuous viral replication long past standard recovery windows.
Immunocompromised Patients May Face Persistent Viral Replication
- Persistent Infection: While most people clear SARS-CoV-2 within two weeks, immunocompromised patients can host active viral replication for months.
- The Treatment Limit: Standard antiviral drugs like remdesivir and anti-inflammatory steroids like dexamethasone may fail when a patient cannot generate their own protective antibodies.
The 127-Day Clinical Course of SARS-CoV-2 Persistence
Most individuals infected with SARS-CoV-2 clear the pathogen within one to two weeks, erasing viral RNA from the respiratory tract as symptoms resolve. The case documented by F. Khamseh, A.-H. Moghtader‐Mojdehi, Z. Nemati, and M. Haghighi (2026) in Respirology Case Reports illustrates the opposite extreme. A 69-year-old woman diagnosed with chronic lymphocytic leukaemia (CLL) four years prior yielded positive RT-PCR results from nasopharyngeal samples for 127 days following the onset of her COVID-19 symptoms.
For the two years leading up to her COVID-19 diagnosis, the patient received ibrutinib, a targeted Bruton tyrosine kinase inhibitor utilized as maintenance therapy. Twenty-eight days later, she returned with fever and weakness.
Clinicians promptly discontinued ibrutinib to reduce immunosuppressive burden. They administered dexamethasone to manage systemic inflammation and remdesivir to curb viral replication. Despite this conventional therapeutic arsenal, serial RT-PCR tests continued to detect the viral genome. The patient’s blood work revealed extensive systemic impairment, featuring 88 percent lymphocytes among a white blood cell count totalling 50 × 10⁹ per litre, an erythrocyte sedimentation rate measured at 119 mm/hour, alongside a C-reactive protein level of 200 mg/L. By day 127, her oxygen saturation declined sharply, resulting in her death in the intensive care unit.
CLL Immunodeficiency Leads to Unchecked Viral Replication
The study authors attribute this prolonged viral shedding to the profound immunodeficiency inherent to CLL, compounded by chemotherapy and ibrutinib therapy. Central to this vulnerability is hypogammaglobulinemia, a hallmark of CLL where protective IgG, IgA, and IgM antibody levels fall below functional thresholds. Without a humoral immune system capable of mounting a competent antibody response, viral replication proceeds unchecked.
This failure to seroconvert aligns with broader clinical patterns. Research demonstrates that patients with CLL experience higher rates of severe COVID-19, hospitalization, ICU admission, and mortality compared to the general population. Advanced age further compounds these risks.
| Clinical Parameter | Patient Status / Value | Clinical Significance |
|---|---|---|
| Duration of Viral Shedding | 127 Days | Reflects continuous, unchecked viral replication rather than lingering molecular debris. |
| White Blood Cell Count | 50 × 10⁹ / L (88% lymphocytes) | Demonstrates high leukaemic burden and severe immune dysfunction. |
| C-Reactive Protein (CRP) | 200 mg/L | Indicates vigorous, persistent systemic inflammation. |
| Therapeutic Interventions | Ibrutinib cessation, Remdesivir, Dexamethasone | Standard hospital protocol, which proved insufficient to halt viral replication. |
The case shows the limits of standard therapies developed for hosts with intact immune systems. Remdesivir, a nucleotide analogue prodrug inhibiting viral RNA-dependent RNA polymerase, and dexamethasone, a corticosteroid dampening the inflammatory cascade, cannot suffice when a patient cannot generate neutralizing antibodies.
References
- Khamseh, F., Moghtader‐Mojdehi, A.-H., Nemati, Z., & Haghighi, M. (2026). A Clinical Evaluation of Ongoing SARS ‐ CoV ‐2 RNA Detection lasting 127 Days Post-Symptom Onset in a Chronic Lymphocytic Leukaemia Sufferer. Respirology Case Reports, 14(10), Article e70767. https://doi.org/10.1002/rcr2.70767
Disclaimer: This article is for informational and educational purposes only and does not substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.
