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COVID-19 and CML: Case Report Involving Febrile Neutropenia and ARDS

By: Sarah Campen, PharmD
Posted: Wednesday, August 5, 2020

A case report of COVID-19 infection in a 65-year-old man with accelerated-phase chronic myeloid leukemia (CML) treated with dasatinib was published in Case Reports in Oncology. His case was complicated by febrile neutropenia and acute respiratory distress syndrome (ARDS), possibly due to a severe COVID-19 cytokine storm. “Although ground-glass opacities are the typical radiological features of COVID-19, it could present with other radiological findings like unilateral or bilateral pleural effusion and might be complicated by ARDS, as in our case,” stated Mohamed A. Yassin, MD, of the Hamad Medical Corporation, Doha, Qatar, and colleagues.

The patient—who was diagnosed with accelerated-phase CML 4 years prior, treated with dasatinib at 100 mg, and in major molecular remission—presented to the emergency department with a 3-day history of fever, progressive shortness of breath with exertion, and a productive cough with intermittent pleuritic chest pain. His oxygen saturation was 94% on six liters; a chest x-ray showed bilateral lower lobe collapse and consolidation with pleural effusion. Labs revealed pancytopenia and a test for COVID-19 was positive.

The patient was admitted and started on hydroxychloroquine, azithromycin, oseltamivir, and piperacillin/tazobactam; dasatinib was held. On day 4, he appeared to improve and was removed from oxygen therapy but had worsening neutropenia.

On day 8, the patient had worsening dyspnea, tachypnea, and tachycardia, required 10 liters of oxygen to maintain an oxygen saturation above 94%, and a chest x-ray showed bilateral infiltrations. He was diagnosed with ARDS and admitted to the intensive care unit, where he received ritonavir, lopinavir, and methylprednisolone.

On day 12, the chest x-ray showed lung field expansion, and right-sided pleural effusion was still noted. His oxygen saturated increased. By day 30, dasatinib continued to be held due to continued neutropenia, but he was awaiting discharge pending a negative repeat COVID-19 test. 

Disclosure: The authors reported no conflicts of interest.

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