A case report out of China suggested that clinical and biochemical data of COVID-19 might have been partly masked in a patient with chronic lymphocytic leukemia (CLL).1
Specifically, a patient presenting in Wenzhou, China, with CLL who was diagnosed with COVID-19 appeared to have a disease incubation period of about 25 days. The patient had traveled to Wuhan between January 12-18, 2020, before traveling back to Wenzhou and self-isolating for 14 days. He presented to the hospital on February 16 after four days of symptoms.
“Without the complete travel history, COVID-19 infection was not initially suspected, because his whole blood cell and lymphocyte counts were high because of his chronic lymphocytic leukemia masking a potential infection,” the case report authors wrote. “However, the attending physician noticed that although symptoms could be the result of a recurrent infection, his chest CT scan resembled that of a patient with COVID-19.”
After testing positive, the patient began treatment with reduced dose of oral chlorambucil to treat his condition due to CLL and received the recommended treatment for COVID-19 in China: nebulized α-interferon (5 million IUs) twice per day, intravenous human immunoglobulin (20 g) once per day, and intravenous methylprednisolone (40 mg) every 12 hours.
The patient had relapsing fever PaO2/FiO2 less than 300 mm Hg and a sequential organ failure assessment score of 4. Noninvasive ventilation therapy was given until dyspnea subsided on day 8 of treatment. Treatment was changed to low-dose methylprednisone every 12 hours with oral chlorambucil twice per day for the next 4 days.
Follow-up CT showed substantial improvement and the patient’s temperature also returned to normal. A repeat COVID-19 test showed the patient remained positive for the virus and an additional 7 days of observation was recommended.
Based on this case, the authors said better diagnostic strategies could be used for diagnosis, and individuals with compromised immune status may be subject to a longer disease incubation period.
“It remains uncertain whether the combination of chemotherapy, corticosteroids, α-interferon, and immunoglobulins could work synergistically in patients with chronic lymphocytic leukemia and COVID-19,” they wrote.
- Jin XH, Zheng KI Pan KE, et al. COVID-19 in a patient with chronic lymphocytic leukaemia [published online April 1, 2020]. Lancet Haematol. doi: 10.1016/S2352-3026(20)30074-0