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Case Reports
. 2021 Jan 25:10:582901.
doi: 10.3389/fonc.2020.582901. eCollection 2020.

Case Report: B Lymphocyte Disorders Under COVID-19 Inflammatory Pressure

Gloria Taliani  1   2   3 , Elena Follini  4 , Lorenzo Guglielmetti  1   5   6 , Patrizia Bernuzzi  4 , Alberto Faggi  1 , Patrizia Ferrante  1   7 , Elisa Fronti  1 , Laura Gerna  1 , Maria Cristina Leoni  1 , Franco Paolillo  1 , Giovanna Ratti  1 , Alessandro Ruggieri  1 , Caterina Valdatta  1 , Alessandra Donisi  8 , Adriano Zangrandi  9 , Lara Pochintesta  4 , Carlo Moroni  4 , Daria Sacchini  1 , Daniele Vallisa  4 , Mauro Codeluppi  1 ; COVID-Piacenza Group
Collaborators, Affiliations
Case Reports

Case Report: B Lymphocyte Disorders Under COVID-19 Inflammatory Pressure

Gloria Taliani et al. Front Oncol. .

Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects humans through the angiotensin converting enzyme-2 (ACE-2) receptor expressed on many cells, including lymphocytes. In Covid-19 patients IL-6 is overexpressed, and hyperactivated plasmacytoid lymphocytes are detected in peripheral blood film. We hypothesize that, due to the unpredictable interaction between the new virus and the B cell lineage of infected patients, a cascade of out of control events can ensue, capable of determining unexpected pathologic disorders involving such lineage. Here we report two cases of autoimmune hemolytic anemia (AIHA) and two cases of B-cell hematological malignancies developed or reactivated during acute SARS-CoV-2 infection. The temporal relationship of the events may suggest a potential causal relationship between SARS-CoV-2 infection and the hematopoietic disorders. We suggest that special attention should be paid to COVID-19 patients with underlining B cell lineage disorders.

Keywords: B-cell lineage malignancies; COVID-19; acute lymphoblastic leukemia; autoimmune hemolytic anemia; multiple myeloma; reactivation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hematologic, clinical, and virological data of patient #1, indicating the concomitant occurrence of hemolysis and virus SARS-CoV-2 detection in nasal swab.
Figure 2
Figure 2
Patient #3. Bone marrow biopsy performed on November, 2019 when multiple myeloma was diagnosed; bone marrow and skin biopsies performed on March, 2020 at the time of hospital admission with COVID-19. (A, B) Patient-3 bone marrow biopsy at diagnosis (11/11/2019), showing clonal plasma-cells scattered or in small groups, accounting for 15% of infiltrate (Giemsa staining: ►; CD138 immunohistochemical staining: ➞) (C, D) Second bone marrow biopsy post-acute COVID-19 infection (23/04/2020) showing abnormal and massive plasma-cellular infiltrate by Giemsa staining (right) (►) and CD138 immunohistochemical staining (➞), with immature morphology and evidence of angioinvasion. (E, F) Skin biopsy post COVID-19 infection (28/04/2020) showing massive plasma-cell infiltrate in subcutaneous fat. (A, B) 400× magnification. (C–F): 200× magnification. (A, C, E): Giemsa staining. (B, D, F): CD138 immuno-histochemical staining.
See this image and copyright information in PMC

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