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. 2022 Aug 15;61(16):2523-2526.
doi: 10.2169/internalmedicine.9136-21. Epub 2022 May 31.

Prolonged COVID-19 in an Immunocompromised Patient Treated with Obinutuzumab and Bendamustine for Follicular Lymphoma

Yayoi Ueda  1 , Shoji Asakura  1 , Sae Wada  2 , Takashi Saito  3 , Tomofumi Yano  1
Affiliations

Prolonged COVID-19 in an Immunocompromised Patient Treated with Obinutuzumab and Bendamustine for Follicular Lymphoma

Yayoi Ueda et al. Intern Med. .

Abstract

A patient with follicular lymphoma treated with obinutuzumab and bendamustine experienced prolonged coronavirus disease-2019 (COVID-19). One month after the symptoms transiently improved, the patient experienced exacerbated COVID-19 symptoms. The patient recovered from COVID-19 with remdesivir and dexamethasone and was discharged 77 days after the disease onset. The patient completed a primary series of SARS-CoV-2 vaccinations on day 176, but the anti-spike protein IgG was not detected later. A careful observation to detect any subsequent relapse of COVID-19 symptoms is necessary in immunocompromised patients. Chemotherapy should be based on the disease status and type of lymphoma.

Keywords: follicular lymphoma; immunocompromised patient; obinutuzumab and bendamustine; prolonged COVID-19.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Clinical course and CT findings of a patient with follicular lymphoma who contracted COVID-19. The patient presented with a three-day history of a fever and rhinorrhea and was diagnosed with COVID-19 (positive SARS-CoV-2 PCR test). She was placed in a residential medical facility on day 4, after which the symptoms resolved, and she was discharged on day 13. After remaining asymptomatic, she underwent a fifth course of GB. The day after completing the fifth course, however, the fever and cough reappeared (day 37). On day 43, a SARS-CoV-2 PCR test was positive, with Ct values of 33.9 (E gene) and 36.4 (N2 gene). CT axial images of the chest. Day 43 CT showed diffuse bilateral ground-glass opacities and infiltrations. On day 47, she was hospitalized and received 60 mg prednisolone for suspected organizing pneumonia, but the fever and respiratory symptoms did not improve. A SARS-CoV-2 PCR test was positive, with Ct values of 34.3 (E gene) and 35.9 (N2 gene). Day 53 CT showed worsening bilateral ground-glass opacities and infiltrations. After a 5-day course of remdesivir and 6.6 mg dexamethasone, day 76 CT showed regression of the bilateral ground-glass opacities and infiltrations. On day 77, she was discharged. CT: computed tomography, Ct: cycle threshold, GB: obinutuzumab and bendamustine
Figure 2.
Figure 2.
Clinical measurements during treatment of COVID-19 relapse in a patient with follicular lymphoma. On hospital admission (day 47), the patient displayed a fever (blue line) and cough (red bar). To improve blood oxygen (orange line), we administered 1 L/min supplemental oxygen (gray bar). Oral prednisolone (green bar) was administered to treat organizing pneumonia, but the symptoms did not improve. A 5-day course of remdesivir (orange bar) and intravenous dexamethasone (6.6 mg, purple bar) led to clinical improvement. The symptoms did not recur during dexamethasone tapering. On day 77, the patient was discharged with a prescription of 1.5 mg oral dexamethasone daily. SpO2: blood oxygen saturation, BT: body temperature
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