COVID-19 Infection Reported in Chinese Patient With CLL
Posted: Tuesday, March 31, 2020
In The Lancet Haematology, Xiang-Hong Jin, MD, of The First Affiliated Hospital of Wenzhou Medical University, China, and colleagues, described a case of coronavirus 2019 (COVID-19) infection in a patient with chronic lymphocytic leukemia (CLL) and a history of non-Hodgkin lymphoma. “Clinical and biochemical data of COVID-19 might be partly masked by coexisting CLL,” they noted. Additionally, “it remains uncertain whether the combination of chemotherapy, corticosteroids, α-interferon, and immunoglobulins could work synergistically in patients with CLL and COVID-19 infection.”
The 39-year-old man presented to the clinic in Wenzhou, China, after 4 days of fever, sore throat, productive cough, and dyspnea. He had been noncompliant with oral chlorambucil therapy for CLL for 3 months prior to presentation.
Upon admission, relevant clinical findings included elevated body temperature (101.3°F), white blood cell count (91,850 cells/μL), and lymphocyte percentage (96%); as well as low hemoglobin (8.5 g/dL) and platelet count (79,000/μL). Plasma concentrations of IgG, IgM, and IgA were also reduced. Although recurrent infection was initially suspected, a CT scan of the chest showed bilateral ground-glass opacities and a small amount of fluid in the left pleural cavity—consistent with COVID-19—and subsequent testing for COVID-19 was positive.
The patient began treatment with a reduced dose of oral chlorambucil, nebulized α-interferon, intravenous human immunoglobulin, and intravenous methylprednisolone. During the first nine days, the patient had relapsing fever, a Sequential Organ Failure Assessment score of 4—indicative of a high degree of organ dysfunction/failure—and was given noninvasive ventilation therapy until dyspnea subsided.
Two weeks after admission, the patient’s temperature returned to normal, with improvement in symptoms, and a follow-up chest CT showed marked reduction in pulmonary exudative lesions. After retrospective review of the patient’s travel history, the authors estimated an incubation period of approximately 25 days. “This case is interesting because the estimated incubation period for COVID-19 infection is thought to be no more than 14 days, according to the Chinese interim guidance,” they concluded.
Disclosure: The study authors reported no conflicts of interest.
