Persistent SARS-CoV-2 Infection in an Immunocompromised Host Treated Successfully With the Japanese Herbal Medicine, Mao-to: A Case Report
Abstract
BACKGROUND Persistent COVID-19 in immunocompromised patients, such as those with B-cell depletion or hematologic malignancies, is an important clinical challenge. Clinically, cases that do not respond to guideline-based antivirals, such as molnupiravir, remdesivir, and nirmatrelvir/ritonavir, are occasionally encountered, but effective therapeutic alternatives remain scarce. We report a case of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection unresponsive to guideline-based antivirals, for which the traditional Japanese herbal medicine Mao-to (Ma-huang-tang) led to clinical improvement. CASE REPORT A 62-year-old man, who underwent treatment for follicular lymphoma with anti-cluster of differentiation-20 antibody and achieved remission, developed persistent SARS-CoV-2 infection. Despite 1 course of molnupiravir and nirmatrelvir/ritonavir each and multiple courses of remdesivir and corticosteroids each, SARS-CoV-2 infection persisted for over 2 months. Following these treatments, the SARS-CoV-2 polymerase chain reaction cycle threshold (Ct) value was 27.6, indicating active COVID-19. Given the lack of further treatment options and clinical stability, Mao-to (Ma-huang-tang), a Japanese herbal medicine ("Kampo"), was then administered as a commercially available extract granule (2.5 g, 3 times daily) for 14 days. The SARS-CoV-2 polymerase Ct value improved to 41, suggesting a marked reduction in viral load, with improved clinical symptoms.…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 19 participants or records.
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