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COVID-19, Merkel Cell Carcinoma, and Immunotherapy: Case Study

By: Sarah Campen, PharmD
Posted: Monday, October 12, 2020

A case of COVID-19 infection in a patient with advanced Merkel cell carcinoma and treated with immunotherapy was recently described in the journal Future Medicine. The patient experienced serious respiratory complications—initially suspected to be immune-related pneumonitis attributable to immunotherapy with pembrolizumab—that required invasive mechanical ventilation.

The authors cautioned clinical and radiologic similarities between COVID-19 and immune checkpoint inhibitor–induced pneumonitis, which can be difficult to discern. “A careful evaluation of oncologic patients receiving immunotherapy during the COVID-19 pandemic is of utmost importance,” stated Rodrigo Ramella Munhoz, MD, of Hospital Sírio-Libanês, São Paulo, Brazil, and colleagues.

The 66-year-old man was diagnosed with metastatic Merkel cell carcinoma in 2018. After achieving a complete metabolic response in November 2019, he had received 13 cycles of maintenance therapy with pembrolizumab. He presented to the hospital with fever in March 2020, and although he had no respiratory symptoms, chest CT revealed a bilateral pulmonary inflammatory pattern. Immunotherapy was suspended, and the patient was advised to isolate at home.

He returned on day 7 due to dyspnea, and testing confirmed COVID-19 infection and worsening pulmonary findings, including ground-glass opacities. The patient soon developed acute respiratory distress syndrome and acute kidney injury. As a result, he was initiated with mechanical ventilation plus wide-spectrum antibiotics. His stay was complicated by impaired consciousness despite sedation withdrawal and deep vein thrombosis in the brachial vein. A tracheostomy was performed on day 25. The patient ultimately experienced ventilatory and neurologic improvement, in addition to prolonged rehabilitation, until hospital discharge on day 81.

“Gathering evidence to better characterize the spectrum of manifestations of COVID-19 and to guide tailored management algorithms in patients receiving [immune checkpoint inhibitors] remains of utmost importance,” concluded the authors.

Disclosure: For full disclosures of the study authors, visit

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