COVID-19 Pneumonia with Migratory Pattern in Agammaglobulinemic Patients: A Report of Two Cases and Review of Literature

Antoni, Melania Degli; Crosato, Verena; Pennati, Francesca; Borghesi, Andrea; Cristini, G; Allegri, Roberto; Capone, Susanna; Bergamasco, A.; Soresina, Annarosa; Badolato, Raffaele; Maroldi, Roberto; Quiros-Roldan, Eugenia; Matteelli, Alberto; Castelli, Francesco; Focà, Emanuele

doi:10.3390/tomography9030073

Cited by 1 publication

(3 citation statements)

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“…Our observations align with a hypothesis stemming from a report on patients with XLA, which suggests that this migratory phenomenon is likely a result of a lack of immune-mediated response due to impaired humoral (B-cell) immunity, which hinders the establishment of a proper inflammatory reaction in the lungs [ 14 ]. Interestingly, in patients with migratory pneumonia, we seldom observed parenchymal bands or reticular opacities in areas where opacities previously existed on CT scans.…”

Section: Further Discussionsupporting

confidence: 90%

“…Interestingly, all patients who had used anti-CD20 agents within one year exhibited migration of airspace opacities during SARS-CoV-2 infection. Three additional patients who showed migratory pneumonia during SARS-CoV-2 infection had either X-linked agammaglobulinemia (XLA) [ 14 ], which is a condition characterized by an inability to produce B-cells, or were undergoing treatment with tirabrutinib [ 21 ], a Bruton’s tyrosine kinase (BTK) inhibitor that inhibits pathways associated with B-cell proliferation and development. In fact, BTK is known to be defective in XLA [ 33 ], and one study revealed that the pooled antibody responses after COVID-19 vaccination were the lowest (15% and 23%, respectively) for patients who had used anti-CD20 therapy within one year prior to COVID-19 diagnosis and a BTK inhibitor [ 34 ].…”

Section: Further Discussionmentioning

confidence: 99%

“…Additional methodological details are provided in Figure 1 and in the Supplementary Methods and Supplementary Tables 1, 2 . This review included 19 studies that reported on a total of 24 patients (median age, 54.5 years [interquartile range (IQR) 44–64 years]; 15 male) [ 7 8 9 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ].…”

Section: Systematic Search and Analysis Of Literaturementioning

confidence: 99%

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Radiologic Abnormalities in Prolonged SARS-CoV-2 Infection: A Systematic Review

Beck,

Yoon,

Yoon

2024

Korean J Radiol

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We systematically reviewed radiological abnormalities in patients with prolonged SARS-CoV-2 infection, defined as persistently positive polymerase chain reaction (PCR) results for SARS-CoV-2 for > 21 days, with either persistent or relapsed symptoms. We extracted data from 24 patients (median age, 54.5 [interquartile range, 44–64 years]) reported in the literature and analyzed their representative CT images based on the timing of the CT scan relative to the initial PCR positivity. Our analysis focused on the patterns and distribution of CT findings, severity scores of lung involvement on a scale of 0–4, and the presence of migration. All patients were immunocompromised, including 62.5% (15/24) with underlying lymphoma and 83.3% (20/24) who had received anti-CD20 therapy within one year. Median duration of infection was 90 days. Most patients exhibited typical CT appearance of coronavirus disease 19 (COVID-19), including ground-glass opacities with or without consolidation, throughout the follow-up period. Notably, CT severity scores were significantly lower during ≤ 21 days than during > 21 days ( P < 0.001). Migration was observed on CT in 22.7% (5/22) of patients at ≤ 21 days and in 68.2% (15/22) to 87.5% (14/16) of patients at > 21 days, with rare instances of parenchymal bands in previously affected areas. Prolonged SARS-CoV-2 infection usually presents as migrating typical COVID-19 pneumonia in immunocompromised patients, especially those with impaired B-cell immunity.

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Section: Further Discussionsupporting

confidence: 90%