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COVID‐19 and CLL: Case Report of Viral Co-infection With Parainfluenza

By: Joseph Cupolo
Posted: Monday, August 24, 2020

A case report published in the European Journal of Haematology discussed the management of a patient with chronic lymphocytic leukemia (CLL) whose treatment was complicated by COVID‐19 and parainfluenza 4 co‐infection. Petra Langerbeins, MD, of the University Hospital, Cologne, Germany, and colleagues encouraged clinicians caring for such patients to thoroughly evaluate respiratory samples to detect bacterial, viral, and fungal superinfections.

A 52‐year‐old male patient with CLL tested positive for severe SARS‐CoV‐2 infection. Regarding his CLL, the patient had experienced slow disease progression with increasing lymphocytosis and lymphadenopathy after having received first‐line therapy with 12 cycles of venetoclax plus 6 cycles of rituximab until 15 months prior to his diagnosis of COVID‐19. At the time of a positive SARS‐CoV‐2 test, he presented with a productive cough present for 5 days, ageusia, and hyposmia.

Due to his good general condition and mild symptoms, the patient was put under home quarantine, with regular follow‐up telephone visits scheduled. However, 1 week later, he was admitted to the hospital due to a deteriorating general state of health with increasing respiratory distress and 5 days after that, the patient was admitted to a medical intensive care unit due to further respiratory deterioration. Four days later, a respiratory virus panel detected parainfluenza 4 virus. In addition, CLL progression was evident, with enlarged mediastinal plus bilateral axillary lymph nodes and splenomegaly.   

Management consisted of high‐flow oxygen supplementation for 4 days followed by oxygen administration via nasal cannula. Probatory therapy with oral hydroxychloroquine (200 mg daily) was also administered.

Further assessment indicated that serum IgG antibodies targeting the S1 domain of the spike protein of SARS‐CoV‐2 became detectable at low titer. With the antibody detection, there was rapid improvement in the respiratory situation, and the patient was transferred to normal care. 

Disclosure: The study authors reported no conflicts of interest.

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