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Jennifer R. Brown, MD, PhD


Could CLL Be Unmasked in Susceptible Individuals With COVID-19 Infection?

By: Lauren Harrison, MD, MS
Posted: Wednesday, June 15, 2022

Although chronic lymphocytic leukemia (CLL) is a known risk factor for severe COVID-19, there are a handful of cases suggesting that COVID-19 infection may uncover CLL in susceptible individuals. One case was discussed by Thaddeus Bartter, MD, of the University of Arkansas for Medical Sciences, Little Rock, and his colleagues, in Cureus.

The patient in this case report is a 55-year-old man who presented to the hospital after 1 week of shortness of breath, dry cough, and fever. Although he required oxygen support, the rest of his vital signs were within normal limits. An initial workup revealed a positive COVID-19 polymerase chain reaction test, a neutrophilic lymphocytosis (total leukocytes > 12,000), mild hyponatremia, and elevated inflammatory markers.

The patient was originally treated with dexamethasone, remdesivir, and antibiotics for a possible superimposed bacterial pneumonia, and he received a dose of tocilizumab on day 3 of hospitalization. He progressively declined and developed increasing oxygen requirements. Imaging on day 7 of admission revealed acute pulmonary emboli and extensive bilateral parenchymal disease.

During his hospitalization, the patient developed progressive lymphocytosis (peaking at 14 x 103/µL) and neutrophilia (peaking at 32 x 103/µL), and his white blood cell count peaked at 78.5 x 103/µL on hospital day 15. A blood smear on day 9 showed no evidence of myelocytes or blasts; however, a repeat smear on day 15 revealed smudge cells suggestive of CLL. Flow-cytometry analysis confirmed the diagnosis of CLL on day 16. The patient eventually required intubation and died on day 29 of hospitalization.

It is well established that COVID-19 infection stimulates an intense immune response, leading to elevations in interleukin-1 (IL-1), IL-6, and IL-8, as well as tumor necrosis factor-α. According to the authors, these inflammatory markers may have released a previously dormant clone of malignant B cells in the patient, destroying previously effective immune control, allowing for an “escape” of the dormant malignancy.

Disclosure: The study authors reported no conflicts of interest.

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