key: cord-0974253-krl77fmv
authors: Onaka, Takashi; Iwai, Fumie; Kato‐Ogura, Aiko; Yonezawa, Akihito
title: Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection after allogeneic stem cell transplantation
date: 2020-06-10
journal: Clin Case Rep
DOI: 10.1002/ccr3.2984
sha: 3a07ac61a5caf3a6083a932107d3f5ebd529d313
doc_id: 974253
cord_uid: krl77fmv

This is the first report of a case of COVID‐19 after allogeneic stem cell transplantation. Our case suggests that COVID‐19 may exist without characteristic CT images, especially in immunocompromised hosts, such as patients after transplantation.

A 61-year-old male with diffuse large B-cell lymphoma transformed from follicular lymphoma underwent peripheral blood stem cell transplantation (PBSCT) from his HLA haploidentical daughter. He underwent de-escalation of immunosuppressant drugs because of early relapse after PBSCT. The duration of chronic graft-vs-host disease (GVHD) was extended, but he did not need additional therapy. At day 205 after PBSCT, he had a fever of 100°F and a wet cough. He visited our hospital because his symptoms persisted for 2 days. He had not travelled to a foreign country nor had contact with anyone with COVID-19. His chest X-ray showed no apparent bacterial pneumonia, and a CT scan showed only small nodules that were diagnosed as scar tissue from past organizing pneumonia and pleural effusion ( Figure 1 ). Although he was radiographically atypical for COVID-19, a COVID-19 PCR test was performed on a nasopharyngeal swab. Laboratory tests showed leucopenia (WBC 1000/µL), neutropenia (ANC 20/µL), a high procalcitonin level (8.94 ng/mL), and a high CRP level (26.3 mg/dL). He was hospitalized and started taking antibiotics with a diagnosis of community-acquired pneumonia. PCR was positive the day after hospitalization. By the ninth day in the hospital, his respiratory condition had not worsened.

Currently, COVID-19 is spreading around the world, and typical COVID-19 clinical features and imaging patterns on chest CT have been reported. Although common symptoms of COVID-19 include fever and respiratory symptoms, a report indicated that COVID-19 was diagnosed without showing the typical symptoms. 2 They reported a patient was admitted to their hospital because of a temporary loss of consciousness, and no respiratory symptoms or fever was observed. Furthermore, their report suggested that COVID-19 diagnosis by symptoms alone can be difficult. On the other hand, in the image findings, Chinese researchers revealed bilateral lung opacities on chest CT in COVID-19-infected patients and described lobular and subsegmental areas of consolidation as the most typical 2 | ONAKA et Al.

findings. 3 Another study found that the hallmarks of COVID-19 on imaging were bilateral and peripheral ground-glass and consolidative pulmonary opacities. 4 However, in our patient, we did not find typical findings on CT. This is the first report of a case of COVID-19 after allogeneic stem cell transplantation. The absence of the characteristic imaging features might be related to leucopenia or immunosuppression. Our case suggests that COVID-19 may exist without characteristic CT images, especially in immunocompromised hosts, such as patients after transplantation.

Although there are many unclear points about COVID-19, typical features may not be present on images, and it is important to note the possibility of infection, especially in immunocompromised patients. 

World Health Organization. Novel coronavirus -China

Atypical presentation of novel coronavirus disease 2019 (COVID-19)

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection

Published with written consent of the patient.

None declared.

TO: managed the patient and wrote the manuscript. FI, AO, and AY: co-ordinated and approved the final version of the manuscript.