The impact of infection with SARS-CoV-2 (COVID-19) varies widely depending on individual factors such as age and associated comorbidities. We report the case of a 39-year-old man, overweight (BMI 29), who was admitted to an Intensive Care Unit in 2021 due to respiratory failure associated with COVID-19. He received three doses of the COVID-19 vaccine, with the last dose in 2023; because he was not classified as belonging to a high-risk group, he did not receive booster doses in 2024 and 2025. In March 2025, after three days of symptoms, he sought medical care and was treated symptomatically. After seven days of symptoms, he developed Severe Acute Respiratory Syndrome (SARS), arriving at a referral hospital with oxygen saturation of 84%, tachypnea (34 breaths/min), respiratory effort, diffuse crackles, and mental confusion. High-resolution chest CT showed >70% lung involvement with a ground-glass pattern. A nasal swab antigen test was positive for SARS-CoV. High-flow nasal oxygen, dexamethasone, and anticoagulation were initiated; however, he worsened clinically, requiring orotracheal intubation (OTI) and mechanical ventilation with high PEEP and neuromuscular blockade, in addition to sedation and analgesia due to frank respiratory failure. He evolved with signs of shock of probable septic origin after five days of OTI; empiric antimicrobial therapy and vasoactive drugs were added, but he died after seven days in the ICU. This case illustrates the severity of the disease in a patient without significant comorbidities, but with a prior severe infection, who was not considered eligible for additional vaccine doses nor for the use of nirmatrelvir/ritonavir, according to the current Brazilian Ministry of Health protocol. This case should alert health authorities to reinfection situations in which the previous episode evolved to severe disease—circumstances in which the patient might be at risk of an unfavorable course in a new COVID-19 episode and could potentially benefit from nirmatrelvir/ritonavir, a medication included in the Ministry of Health strategic reserve but released only under pre-established criteria. In addition, booster vaccination protocols for COVID-19 should include patients with the profile described in this case report.
Grotti et al. (Sun,) studied this question.