Successive SARS-CoV-2 mutations in a highly susceptible host: A case report of persistent viremia and fatality

Yuko Danzuka; Keiji Nakamura; Shinya Matsumoto; Yoshitaka Etoh; Sho Yamasaki; Koji Takayama; Masayuki Murata; Nobuyuki Shimono

doi:10.1016/j.jiac.2025.102737

Successive SARS-CoV-2 mutations in a highly susceptible host: A case report of persistent viremia and fatality

Yuko Danzuka
, Keiji Nakamura
, Shinya Matsumoto
, Yoshitaka Etoh
, Sho Yamasaki
, Koji Takayama
, Masayuki Murata
, Nobuyuki Shimono

Research output: Contribution to journal › Article › peer-review

Abstract

A 71-year-old female with post-treatment follicular lymphoma developed COVID-19 with persistent viremia. Despite the initiation of remdesivir on day 23, she remained SARS-CoV-2 PCR-positive and ultimately succumbed to respiratory failure on day 79. Whole-genome analysis of RNA extracted from a post-mortem nasopharyngeal swab identified multiple mutations, including P323L/G671S, which enhances viral replication, and V792I, associated with remdesivir resistance. This case highlights the challenges of managing persistent SARS-CoV-2 infection in immunocompromised patients and underscores the impact of delayed treatment and antiviral resistance.

Original language	English
Article number	102737
Journal	Journal of Infection and Chemotherapy
Volume	31
Issue number	7
DOIs	https://doi.org/10.1016/j.jiac.2025.102737
Publication status	Published - Jul 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

All Science Journal Classification (ASJC) codes

Microbiology (medical)
Pharmacology (medical)
Infectious Diseases

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10.1016/j.jiac.2025.102737

Cite this

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title = "Successive SARS-CoV-2 mutations in a highly susceptible host: A case report of persistent viremia and fatality",

abstract = "A 71-year-old female with post-treatment follicular lymphoma developed COVID-19 with persistent viremia. Despite the initiation of remdesivir on day 23, she remained SARS-CoV-2 PCR-positive and ultimately succumbed to respiratory failure on day 79. Whole-genome analysis of RNA extracted from a post-mortem nasopharyngeal swab identified multiple mutations, including P323L/G671S, which enhances viral replication, and V792I, associated with remdesivir resistance. This case highlights the challenges of managing persistent SARS-CoV-2 infection in immunocompromised patients and underscores the impact of delayed treatment and antiviral resistance.",

keywords = "Genetic mutations, Immunocompromised patients, Persistent viremia, Remdesivir resistance, SARS-CoV-2, Whole-genome sequencing",

author = "Yuko Danzuka and Keiji Nakamura and Shinya Matsumoto and Yoshitaka Etoh and Sho Yamasaki and Koji Takayama and Masayuki Murata and Nobuyuki Shimono",

note = "Publisher Copyright: {\textcopyright} 2025 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control",

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doi = "10.1016/j.jiac.2025.102737",

language = "English",

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T2 - A case report of persistent viremia and fatality

AU - Danzuka, Yuko

AU - Nakamura, Keiji

AU - Matsumoto, Shinya

AU - Etoh, Yoshitaka

AU - Yamasaki, Sho

AU - Takayama, Koji

AU - Murata, Masayuki

AU - Shimono, Nobuyuki

PY - 2025/7

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N2 - A 71-year-old female with post-treatment follicular lymphoma developed COVID-19 with persistent viremia. Despite the initiation of remdesivir on day 23, she remained SARS-CoV-2 PCR-positive and ultimately succumbed to respiratory failure on day 79. Whole-genome analysis of RNA extracted from a post-mortem nasopharyngeal swab identified multiple mutations, including P323L/G671S, which enhances viral replication, and V792I, associated with remdesivir resistance. This case highlights the challenges of managing persistent SARS-CoV-2 infection in immunocompromised patients and underscores the impact of delayed treatment and antiviral resistance.

AB - A 71-year-old female with post-treatment follicular lymphoma developed COVID-19 with persistent viremia. Despite the initiation of remdesivir on day 23, she remained SARS-CoV-2 PCR-positive and ultimately succumbed to respiratory failure on day 79. Whole-genome analysis of RNA extracted from a post-mortem nasopharyngeal swab identified multiple mutations, including P323L/G671S, which enhances viral replication, and V792I, associated with remdesivir resistance. This case highlights the challenges of managing persistent SARS-CoV-2 infection in immunocompromised patients and underscores the impact of delayed treatment and antiviral resistance.

KW - Genetic mutations

KW - Immunocompromised patients

KW - Persistent viremia

KW - Remdesivir resistance

KW - SARS-CoV-2

KW - Whole-genome sequencing

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Successive SARS-CoV-2 mutations in a highly susceptible host: A case report of persistent viremia and fatality

Abstract

UN SDGs

All Science Journal Classification (ASJC) codes

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