Recurrent and persistent fever after SARS-CoV-2 infection in patients with follicular lymphoma: A case series

Whilst persistent or recurrent COVID-19 infection is well described among some immunosuppressed patient cohort, to date there have been no reports of this phenomenon in the context of repeatedly negative SARS-CoV-2 testing in the upper respiratory tract. We reported 6 follicular lymphoma developed recurrent symptomatic COVID-19 infection. They tested persistently negative for SARS-CoV-2 on pharyngeal swabs and ultimately confirmed by BALF metagenomics next generation sequencing. All 6 patients presented with lymphopenia and B-cell depletion, and 5 of them received the anti-CD 20 treatment in the last year. Persistent fever was the most common symptom and bilateral ground glass opacities were the primary pattern on chest computed tomography. A relatively long course of unnecessary and ineffective antibacterial and/or antifungal treatments was administered until the definitive diagnosis. Persistent fever subsided rapidly with nirmatrelvir/ritonavir treatment. Our case highlighted that recurrent COVID-19 infection should be suspected in immunocompromised patients with persistent fever despite negative pharyngeal swabs, and urgent BALF testing is necessary. Treatment with nirmatrelvir/ritonavir appeared to be very effective in these patients.