Persistent SARS-CoV-2 infectivity for more than four months after onset of COVID-19 in an allogeneic stem cell transplant recipient: A case report

The duration of infectivity associated with severe acute respiratory coronavirus-2 (SARS-CoV-2) is generally approximately 10 days from the onset of symptoms. However, some studies have reported that this period may be longer than 20 days in patients with allogeneic hematopoietic stem cell transplantation (HSCT). Herein, we report a case of persistent viral SARS-CoV-2 shedding for 126 days in an individual with HSCT. When the patient was infected with coronavirus disease 2019 (COVID-19), tacrolimus and prednisolone were administered for graft versus host disease. The viral load, which was monitored regularly by quantitative antigen testing, decreased with the administration of antiviral agents but re-elevated rapidly after discontinuation. Tapering of tacrolimus and prednisolone resulted in a gradual reduction of the viral load and its eventual disappearance. This case report highlights the importance of determining persistent infectivity in patients with allogeneic HSCT using viral testing prior to release from isolation.