COVID-19 pneumonia in a patient with adult T-cell leukemia-lymphoma

Abstract

Although some patients with COVID-19 develop only mild symptoms, fatal complications have been observed among those with comorbidities. As patients with cancer are immunocompromised, they are thought to have a high risk of severe illness associated with COVID-19. We report a COVID-19 patient with adult T-cell leukemia-lymphoma (ATL) who was treated using favipiravir. A 69-year-old woman with lymphoma-type ATL was treated using cyclophosphamide, doxorubicin, vincristine, prednisolone and mogamulizumab (M-CHOP) with substantial efficacy. However, in cycle 4 of M-CHOP therapy, she developed fever with mild cough. The patient was admitted to the hospital and CT revealed bilateral ground-glass opacities. SARS-CoV-2 was detected by RT-PCR and the patient was diagnosed with COVID-19. Considering severe immunosuppression caused by ATL, we initiated favipiravir therapy. Subsequently, the fever improved without antipyretics and her C-reactive protein level decreased rapidly. SARS-CoV-2 PCR tests were negative on days 17 and 18 of favipiravir therapy, and the patient was discharged without residual disease on the final CT. This is the first documented case of COVID-19 in a patient with ATL. Although severe immunosuppression caused by ATL was present, severe COVID-19 pneumonia did not develop. The immunosuppressed condition caused by hematological malignancy may not always be a risk factor for severe illness associated with COVID-19. Further accumulation of data regarding COVID-19 in patients with hematological malignancies is warranted to clarify the risk factors for severe illness, the best-in-class antiviral agent, and the optimal treatment strategy in this population.

Utility of Ct values in differentiating COVID-19 reinfection versus prolonged viral shedding in an immunocompromised patient

“…The patient was then treated with favipiravir, responded well and did not develop COVID-19 pneumonia. 10 Similar to our case, this patient received an antiviral medication for COVID-19 and had a positive clinical outcome. Another case report details a 62-year-old woman in China with previously diagnosed ALL who developed COVID-19 approximately 2 weeks after receiving chemotherapy.…”

COVID‐19 in a human T‐cell lymphotropic virus type‐1 carrier

“…There is only one previous case report of COVID-19 in a patient with HTLV-1 infection, in which the patient with ATL recovered without developing secondary infections. 11 However, the reasons for our patient developing a more severe disease than that developed by the patient with ATL are unclear because of the differences in patient backgrounds. The patient with ATL developed COVID-19 while undergoing chemotherapy and was also treated with corticosteroids.…”

The efficacy and adverse effects of favipiravir on patients with COVID-19: A systematic review and meta-analysis of published clinical trials and observational studies

“…After favipiravir administration, the clinical status improved in 74 cases, worsened in 48 cases (with 21 deaths), and was unclear in 20 cases. The reported side effects were hyperuricemia Hosoba et al, 2020;Ono et al, 2020;Takoi et al, 2020 ), fever ( Koba et al, 2020 ;Kurita et al, 2020 ;Takoi et al, 2020 ), lymphocytosis ( Dauby et al, 2021 ), eosinophilia ( Takoi et al, 2020 ), lymphocytopenia ( Atallah et al, 2020 ), hepatotoxicity ( Hosoba et al, 2020 ;Takumida et al, 2021 ;Yamazaki et al, 2021 ), nephrotoxicity ( Nasa et al, 2021 ), acute pancreatitis ( Khan et al, 2021 ), wood's lamp fluorescence on nails and hair, and nausea ( Aslan Kayiran et al, 2021 ).…”