Fig. 1: Clinical course.

After the first course of RDV, the patient’s symptoms improved (Day 11). The patient was re-admitted to the hospital on Day 22 due to worsening physical symptoms. From Day 28, respiratory and renal failure progressed. On Day 36, the patient was transferred to the ICU to undergo haemodialysis. During this time, the patient developed invasive pulmonary aspergillosis caused by Aspergillus tubingensis, and antifungal treatment with voriconazole and micafungin was initiated. On Day 44, neutrophils decreased down to 62/μl. Valganciclovir was the suspected drug causing neutropenia and was discontinued. Treatment with a filgrastim biosimilar (G-CSF: granulocyte colony-stimulating factor) was initiated. Since Pneumocystis pneumonia was also suspected, the dose of trimethoprim/sulfamethoxazole was increased from prophylactic to therapeutic. On Day 62, the patient had a persistent fever; the Ct value of nasopharyngeal specimen was as low as 26.5. Therefore, the third course of RDV was initiated. RDV remdesivir, Ct Cycle threshold, CFPM cefepime, CMZ cefmetazole, MEPM meropenem, ITCZ itraconazole, VRCZ voriconazole, MCFG micafungin, G-CSF granulocyte colony-stimulating factor.