REBOUND COVID-19 AFTER PAXLOVID IN 2 RELATED FAMILY MEMBERS

Abstract

Intro: On May 24, 2022, the CDC issued a healthcare advisory after reports of COVID-19 symptoms returning (COVID-19 rebound) in certain patients two to eight days after treatment with Paxlovid (Ritonavir-Boosted Nirmatrevir). We describe two patients who experienced a rebound of COVID-19 after receiving Paxlovid treatment. Methods: We described a case series involving a 67-year-old father and his 37- year-old daughter who developed high-grade fever with chills and rigors, myalgia, arthralgia, sore throat, rhinorrhea, and non-chesty cough. Both tested for COVID-19 RTK Antigen, which resulted in a positive test. They went to the primary care clinic on day 2 of illness and were prescribed oral Paxlovid therapy for five days. Symptoms significantly resolved during the treatment, and repeated self-tested COVID-19 RTK Ag saliva test on day 4 of treatment yielded a negative result. Findings: On day 9 of illness (Day 3 completion of Paxlovid), both patients developed rebound respiratory symptoms with anosmia. With the doubt of suddenly developed recurrent symptoms with new onset anosmia, they decided to repeat the COVID-19 RTK Ag test, which resulted in positive results. Therefore, they were treated as rebound COVID-19 post-Paxlovid treatment. Symptomatic treatments were given, and they were advised for home quarantine. Discussion: Based on the illustration of the case, the diagnosis dilemma exists whether this is the progression of the disease, rebound phenomena or re- infection. However, given the brief period between presentations, rebound COVID-19 post-Paxlovid is likely. In rebound Covid-19 after Paxlovid, there was no need for other antiviral medication due to the moderate nature of the symptoms experienced by those mentioned. Conclusion: More study is required to describe the host and predisposing genetic characteristics that can aid in recognizing and understanding this phenomenon. In addition, more exploratory and fundamental research is needed to evaluate the severity and clinical characteristics of these patients and to identify the underlying reason.