ArticleThe American journal of case reports2026
Persistent SARS-CoV-2 Infection in an Immunocompromised Host Treated Successfully With the Japanese Herbal Medicine, Mao-to: A Case Report.
Article in The American journal of case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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. CONCLUSIONS Mao-to may offer a cost-effective adjunctive option for persistent COVID-19 in immunocompromised patients who fail to respond to conventional therapies. In addition, 14 days of Mao-to treatment cost approximately 1200 JPY (USD $8), significantly less than extended courses of standard antivirals. This case suggests the potential utility of traditional herbal medicine in managing persistent SARS-CoV-2 infections when conventional therapies fail.
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