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COVID-19 and CLL: Rare Case of Pseudohypoxemia

By: Nahae Kim, MPH
Posted: Friday, October 9, 2020

Pseudohypoxemia, a rare complication in patients with chronic lymphocytic leukemia (CLL), presents with unique treatment implications in the setting of severe infection with SARS-CoV-2, according to a recent case report published in the European Journal of Case Reports in Internal Medicine. Orivaldo Alves Barbosa, MD, of Hospital Geral Dr. César Cals, Fortaleza/Ceará, Brazil, and colleagues recommend delaying or reducing the intensity of chemotherapy regimens, especially for oligosymptomatic patients; using pulse oximetry as a reliable method of evaluating oxygenation, and modifying mechanical ventilation once pseudohypoxemia is identified.

A patient with confirmed CLL was admitted in March 2020 for initial symptoms of fever, sore throat, dry cough, and dyspnea. COVID-19 was later confirmed, and CT revealed “bilateral ground-glass opacities with multifocal confluent mosaic attenuation areas, involving much of the lung parenchyma.” As symptoms progressed, lung-protective ventilation was initiated, along with medication therapy including methylprednisolone, antibiotics, and hydroxychloroquine.

After 2 weeks, while the patient’s oxygen saturation, mechanical ventilation, and radiologic findings improved, there were contradictory findings of a normal pulse oximeter reading and low oxygen pressure values. Suspecting pseudohypoxemia, Dr. Barbosa and colleagues weaned the patient from mechanical ventilation, confirming no indication of low tissue perfusion thereafter.

“It is important for clinicians to recognize this condition to avoid diagnostic and therapeutic errors induced by a falsely low oxygen reading. During mechanical ventilation, unrecognized spurious hypoxemia can cause an inappropriate rise in the inspiratory oxygen fraction, thus exposing patients who are already prone to respiratory complications to additional pulmonary oxygen toxicity,” study authors concluded.

The authors further reminded that patients with CLL, with susceptible immune systems, are at higher risk for contracting COVID-19, especially following intensive chemotherapy. Potentially delaying therapy in patients with few or mild symptoms and considering more moderate chemotherapy regimens are suggested.

Disclosure: The study authors reported no conflicts of interest.



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