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Fig. 1 | Antimicrobial Resistance & Infection Control

Fig. 1

From: Prolonged SARS-CoV-2 infection following rituximab treatment: clinical course and response to therapeutic interventions correlated with quantitative viral cultures and cycle threshold values

Fig. 1

Depiction of prolonged COVID-19 viral shedding in an immunosuppressed patient. A Timeline of patient’s clinical course from time of initial COVID-19 positive swab (day 0). Cycle threshold values and culture viral load are represented. Treatment modalities throughout the clinical course are depicted. R: Remdesivir; B: bamlanivimab; *indicates date of corresponding CT scans depicted in B. Cycle threshold values greater than 40 were considered negative. B Serial CT scans show multifocal, patchy areas of predominantly ground-glass opacities. The first CT scan shown (day 92) was obtained at the time of the second relapse. The subsequent studies (days 118, 132 and 152) were obtained during the third relapse. On each of the serial scans, some areas of involvement improve while there is worsening in other areas, consistent with migratory opacities. There are features of organizing pneumonia, which is typical later in the course of COVID-19 pneumonia. C Transbronchial biopsy. Left image: Low power view of transbronchial biopsy shows alveolated lung parenchyma with expansive interstitial cellular infiltrates composed of lymphocytes and neutrophils. There are subtle occasional foci of organizing pneumonia (blue arrow highlights an intra-alveolar fibroblastic plug of organizing pneumonia) and patchy interstitial fibrosis (hematoxylin–eosin, at original magnification ×10). Right image: High power view with focus of intra-alveolar neutrophils (highlighted with blue arrow) with associated reactive type II pneumocytes lining alveolar spaces (hematoxylin–eosin, at original magnification ×20)

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