The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produces a broad spectrum of respiratory symptoms, from mild to pneumonia and acute respiratory distress syndrome. Coronavirus disease (COVID-19) is associated with an inflammatory syndrome that may increase damage to the lungs. Several hematopoietic and hemostatic abnormalities have been described, as well as autoimmune disorders. 1,2 2 | CASE HISTORY We report a 33-year-old woman, a surgical nurse, with no relevant medical history (although her sister was diagnosed with Hodgkin lymphoma), who was admitted to the Hematology Department at our hospital with severe neutropenia, asthenia, and enlarged lymph nodes 11 days after being diagnosed with COVID-19. On April 1, the patient presented at her family doctor (FD) with a sore throat, asthenia, and myalgia. SARS-CoV-2 polymerase chain reaction revealed positivity on oropharyngeal swabs obtained by the FD on April 2. She did not receive antiviral treatment, only acetaminophen when needed, and was discharged to her home to remain in isolation. Initially, her symptoms improved, but on April 13, she presented to the emergency department because of asthenia, gum swelling, and chills without fever or respiratory symptoms, such as shortness of breath or cough. Her vital signs, including oxygen saturation, were normal, and physical examination showed mild enlargement of the cervical, axillary, and inguinal lymph nodes without other pathological findings. 2.1 | Investigations and treatment Blood counts showed mild leukopenia (3.07 × 10 9 /L) with severe neutropenia (0.33 × 10 9 /L) and eosinopenia (0.05 × 10 9 /L) with a normal lymphocyte count, hemoglobin level, and platelet count. No morphological abnormalities were observed in the peripheral blood smear. Blood biochemistry assessment showed an increased level of C-reactive protein (2.51 mg/dL; normal, <0.5 mg/dL). Her lactate dehydrogenase level, liver function, and renal function were normal. Her interleukin-6 level was 20 pg/mL (normal, <7 pg/ mL). She had a fibrinogen level of 603 mg/dL with a normal D-dimer level. Her chest radiography was normal, and the pregnancy test result was negative. A new oropharyngeal swab for the SARS-CoV-2 test was performed on April 14, which continued to show positivity.

Background Little is known about characteristics of seasonal human coronavirus (HCoV) (NL63, 229E, OC43 and HKU1) after allogeneic stem cell transplantation (allo-HCT). Patients and methods this is a collaborative Spanish and European bone marrow transplantation groups retrospective multicentre study, which included allo-HCT recipients (adults and children) with upper and/or lower respiratory tract disease (U/LRTD) caused by seasonal HCoV diagnosed through multiplex PCR assays from January 2012 to January 2019. Results We included 402 allo-HCT recipients who developed 449 HCoV U/LRTD episodes. Median age of recipients was 46 years (range 0.3-73.8 years). HCoV episodes were diagnosed at a median of 222 days after transplantation. The most common HCoV subtype was OC43 (n=170, 38%). LRTD involvement occurred in 121 episodes (27%). HCoV infection frequently required hospitalization (18%), oxygen administration (13%) and intensive care unit (ICU) admission (3%). Three-month overall mortality after HCoV detection was 7% in the whole cohort and 16% in those with LRTD. We identified 3 conditions associated with higher mortality in recipients with LRTD: absolute lymphocyte count &lt;0.1 x10 9/mL [hazard ratio (HR), 10.8], corticosteroid (HR 4.68) and ICU admission (HR 8.22) (p&lt;0.01). Conclusions Seasonal HCoV after allo-HCT may involve the LRTD in many instances, leading to a significant morbidity.

Background Early Kinetics of SARS‐CoV‐2 viral load (VL) in plasma determined by quantitative RT‐PCR was evaluated as a predictor of poor clinical outcome in a prospective study and assessed in a retrospective validation cohort. Methods Prospective observational single‐centre study including consecutive adult patients hospitalised with COVID‐19 between November 2020 and January 2021. Serial plasma samples were obtained until discharge. Quantitative RT‐PCR was performed to assess SARS‐CoV‐2 VL. The main outcomes were in‐hospital mortality, admission to the Intensive Care Unit (ICU) and their combination (Poor Outcome). Relevant Viremia (RV), established in the prospective study, was assessed in a retrospective cohort including hospitalised COVID‐19 patients from April 2021‐May 2022, in which plasma samples were collected according to clinical criteria. Results Prospective cohort: 57 patients were included. RV was defined as at least a two‐fold increase in VL within ≤2 days or a VL>300 copies/mL, in the first week. Patients with RV (N=14; 24.6%) were more likely to die than those without RV (35.7% vs 0%), needed ICU admission (57% vs 0%) or had Poor Outcome (71.4% vs 0%), (p<0.001 for the three variables) Retrospective cohort: 326 patients were included, 18.7% presented RV. Patients with RV compared with patients without RV had higher rates of ICU‐admission [OR 5.6 (95%CI,2.1‐15.1); p=0.001], mortality [OR 13.5 (95%CI,6.3‐28.7); p<0.0001] and Poor Outcome [OR 11.2 (95%CI,5.8‐22); p<0.0001] Conclusion Relevant SARS‐CoV‐2 viremia in the first week of hospitalisation was associated with higher in‐hospital mortality, ICU admission, and Poor Outcome. Findings observed in the prospective cohort were confirmed in a larger validation cohort. This article is protected by copyright. All rights reserved.

BackgroundInterleukin 6 (IL6) levels and SARS-CoV-2 viremia have been correlated with COVID-19 severity. The association over time between them has not been assessed in a prospective cohort. Our aim was to evaluate the relationship between SARS-CoV-2 viremia and time evolution of IL6 levels in a COVID-19 prospective cohort.MethodsSecondary analysis from a prospective cohort including COVID-19 hospitalized patients from Hospital Universitario La Princesa between November 2020 and January 2021. Serial plasma samples were collected from admission until discharge. Viral load was quantified by Real-Time Polymerase Chain Reaction and IL6 levels with an enzyme immunoassay. To represent the evolution over time of both variables we used the graphic command twoway of Stata.ResultsA total of 57 patients were recruited, with median age of 63 years (IQR [53–81]), 61.4% male and 68.4% Caucasian. The peak of viremia appeared shortly after symptom onset in patients with persistent viremia (more than 1 sample with &gt; 1.3 log10 copies/ml) and also in those with at least one IL6 &gt; 30 pg/ml, followed by a progressive increase in IL6 around 10 days later. Persistent viremia in the first week of hospitalization was associated with higher levels of IL6. Both IL6 and SARS-CoV-2 viral load were higher in males, with a quicker increase with age.ConclusionIn those patients with worse outcomes, an early peak of SARS-CoV-2 viral load precedes an increase in IL6 levels. Monitoring SARS-CoV-2 viral load during the first week after symptom onset may be helpful to predict disease severity in COVID-19 patients.

Background: Interleukin 6 (IL6) levels and SARS-CoV-2 viremia have been correlated with COVID-19 severity. The association over time between them has not been assessed in a prospective cohort. Our aim was to evaluate the relationship between SARS-CoV-2 viremia and time evolution of IL6 levels in a COVID-19 prospective cohort. Methods: Secondary analysis from a prospective cohort including COVID-19 hospitalized patients from Hospital Universitario La Princesa between November 2020 and January 2021. Serial plasma samples were collected from admission until discharge. Viral load was quantified by Real-Time Polymerase Chain Reaction and IL6 levels with an enzyme immunoassay. To represent the evolution over time of both variables we used the graphic command twoway of Stata. Results: A total of 57 patients were recruited, with median age of 63 years (IQR [53-81]), 61.4% male and 68.4% caucasian. The peak of viremia appeared shortly after symptom onset in patients with persistent viremia (more than 1 sample with >1.3 log10 copies/ml) and also in those with at least one IL6>30 pg/ml, followed by a progressive increase in IL6 around 10 days later. Persistent viremia in the first week of hospitalization was associated with higher levels of IL6. Both IL6 and SARS-CoV-2 viral load were higher in males, with a quicker increase with age. Conclusions: In those patients with worse outcomes, an early peak of SARS-CoV-2 viral load precedes an increase in IL6 levels. Monitoring SARS-CoV-2 viral load during the first week after symptom onset may be helpful to predict disease severity in COVID-19 patients.