Therapeutic approach for severe COVID-19 and immunocompromised patients. A case series

• Main Authors: Francesca Simioli, Maria Martino, Anna Annunziata, Novella Carannante, Giuseppe Fiorentino
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: Respiratory Medicine Case Reports
• Subjects: Lymphoma; Immunodeficiency; Immunosuppressant; Anti-CD20; SARS-CoV2 persistence; SARS-CoV2 relapse
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213007121000599

Background: COVID-19 is a potentially critical infectious disease. Inflammatory response and disease severity may vary according to immune system status. The aim of this case series is to investigate different presentation of COVID-19 in immunocompromised patients. Methods: this is a single centre case series about 17 immunocompromised patients admitted to our respiratory department during the recent COVID-19 pandemic. White blood cell count, C reactive protein, interleukin 6, lymphocytic subpopulation count (CD4+, CD8+, CD20+) and immunoglobulin count (IgG, IgM, IgA) were measured at hospitalization. Results: the most common causes of immunosuppression observed in our severe COVID-19 population are hematological malignancies, immunosuppressant drugs for transplant, primary immunodeficiency and inflammatory bowel disease. Onset symptoms were fever (88%), cough (53%), dyspnoea (24%), asthenia (35%), anosmia and/or ageusia (17%), expectoration (12%). Compared to benign conditions, patients with malignancies show a lower lymphocytic count (490 vs 1100 cells/uL) and higher interleukin 6 (33 vs 13 pg/mL). Conclusions: immunocompromised patients are at risk of adverse outcome from COVID-19. Hematological malignancies and anti-CD20 therapies induce a high risk. Primary immunodeficiency and classical immunosuppressant such as calcineurin inhibitors and antimetabolites share an intermediate risk.