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Case Reports
. 2023 Dec 5;15(12):e49974.
doi: 10.7759/cureus.49974. eCollection 2023 Dec.

Relapsing COVID-19 in a Patient With Non-Hodgkin Lymphoma on Chemotherapy

António Carujo  1 , Luís Ferreira  1 , Rui Bergantim  2   3   4 , André Santos Silva  1   5 , António Ludgero Vasconcelos  1   5
Affiliations
Case Reports

Relapsing COVID-19 in a Patient With Non-Hodgkin Lymphoma on Chemotherapy

António Carujo et al. Cureus. .

Abstract

Hematologic malignancies and chemotherapy are risk factors for COVID-19 progression and mortality. Immunocompromised hosts, particularly those with severe B-cell depletion, can shed viable viruses for extended periods, which can lead to persistent infection. We present the case of a 73-year-old male with diffuse large B-cell lymphoma (stage IV-B) under curative immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). After the first episode of mild COVID-19, he developed two severe relapses following the third and fourth cycles of R-CHOP. Lung CT scans performed in both episodes showed new-onset ground-glass infiltrates and fibrosis of previously affected pulmonary segments. In light of similar semiquantitative SARS-CoV-2 viral loads between episodes, without further risk exposure or microbiological findings, persistent COVID-19 with severe clinical relapses was assumed and successfully treated with polyclonal immunoglobulin and remdesivir. Whole-genome sequencing was performed in all samples, confirming the same specimen, which belonged to the B.1.177 lineage. This case stands out for the unusually long viral persistence and the various relapses of severe COVID-19 related to the worsening immune status with each immunochemotherapy cycle.

Keywords: covid-19; immunosuppression therapy; lymphoma; r-chop protocol; rituximab.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Thoracic CT angiography performed in March 2021
Red arrows: bilateral multifocal ground-glass opacities, with adjacent interstitial densification, presenting a crazy paving pattern.
Figure 2
Figure 2. Thoracic CT scan performed in April 2021
Green arrows: fibrosis and bronchiectatic evolution of the previously affected pulmonary segments; red arrows: new ground-glass infiltrates in previously spared areas.
Figure 3
Figure 3. Thoracic CT scan performed in June 2021
Green arrows: fibrosis of the previously affected segments; red arrow: maintenance of some of the ground-glass infiltrates.
See this image and copyright information in PMC

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