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. 2020 Aug 17;7(8):ofaa326.
doi: 10.1093/ofid/ofaa326. eCollection 2020 Aug.

A Case of Steroid-Responsive, COVID-19 Immune Reconstitution Inflammatory Syndrome Following the Use of Granulocyte Colony-Stimulating Factor

Jonathan Mertens  1 , Yassine Laghrib  1 , Chris Kenyon  2   3
Affiliations

A Case of Steroid-Responsive, COVID-19 Immune Reconstitution Inflammatory Syndrome Following the Use of Granulocyte Colony-Stimulating Factor

Jonathan Mertens et al. Open Forum Infect Dis. .

Abstract

We present a case report of a 54-year-old male with metastasized nasopharyngeal carcinoma presenting to the hospital with dyspnea, anorexia and fever. Examination revealed chemotherapy-induced pancytopenia. The patient tested positive for SARSCoV-2, but respiratory complications were mild. The patient was treated with granulocyte-colony stimulating factor (G-CSF) leading to amelioration of the neutropenia. However, severe acute respiratory distress syndrome (ARDS) occurred, prompting the diagnosis of immune reconstitution inflammatory syndrome (IRIS). GCSF is currently investigated as additional therapy in ARDS, but this case report emphasizes that risks and benefits must be carefully assessed. To our knowledge, this is the first case report of IRIS-induced ARDS in a COVID-19 patient.

Keywords: ARDS; COVID-19; IRIS; SARS-CoV-2; granulocyte-colony stimulating factor; immune reconstitution inflammatory syndrome.

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Figures

Figure 1.
Figure 1.
Axial computed tomography thorax image showing predominantly peripheral mild ground-glass opacities compatible with COVID-19 lung injury.
Figure 2.
Figure 2.
Axial computed tomography thorax with contrast image showing acute respiratory distress syndrome with massive worsening of preexisting lesions.
Figure 3.
Figure 3.
Axial computed tomography thorax image showing residual lung injury 12 days after initial acute respiratory distress syndrome. All images illustrated were taken at approximately the same level.
See this image and copyright information in PMC

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