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COVID-19 infection and recurrent infusion reactions: case report A 67-year-old man experienced recurrent infusion reactions during treatment with avelumab for Merkel cell carcinoma (MCC). Additionally, he developed COVID-19 infection following treatment with avelumab and pembrolizumab for MCC [routes and durations of treatment to reactions onsets not stated]. The man, whose medical history was notable for diabetes and hypertension, was diagnosed with MCC (pT2pN0, stage IIA) in 2018 at the age of 66 years. He underwent surgery and adjuvant radiation therapy. In February 2019, a tumour relapse was confirmed; hence, he started receiving avelumab 10 mg/kg infusion every 14 days. He received unspecified prophylactic therapy, however experienced recurrent infusion reactions. Therefore, after 3 cycles, the man’s treatment with avelumab was switched to pembrolizumab 200mg every 3 weeks. In November 2019, he achieved full metabolic response. Following 13 cycles of pembrolizumab (last infusion administered on 5 March 2020), he presented with fever. Chest CT scan revealed a bilateral pulmonary inflammatory pattern, suggestive of an immune-related pneumonitis or viral infection. Pembrolizumab was discontinued. Home isolation was advised with daily medical follow-up. On day 7 (23 March 2020), he was hospitalised due to dyspnoea. RT-PCR testing was found to be positive for SARS-CoV-2, confirming COVID-19. Chest CT scan revealed worsening of his bilateral pulmonary ground-glass opacities. His condition progressed to acute respiratory distress syndrome despite supportive therapy [specific drugs not stated]. He developed acute kidney injury on day 9. He required mechanical ventilation and off-label therapy with azithromycin. On day 12, he started receiving off-label therapy with hydroxychloroquine; however, it was discontinued 5 days later due to development of concurrent supraventricular extrasystoles [aetiology not stated]. He showed improvement in ventilatory parameters and renal function but had impaired consciousness following the discontinuation of unspecified sedatives. He subsequently tested negative for SARS-CoV-2. On day 20, deep vein thrombosis was identified in brachial vein, and he received treatment with unspecified anticoagulants. On day 25, he required a tracheostomy. His condition progressed with ventilatory and neurological improvement and prolonged rehabilitation. He was discharged on 12 June 2020 [not all outcomes stated]. da Costa CM, et al. COVID-19 in a patient with advanced Merkel cell carcinoma receiving immunotherapy. Immunotherapy 12: No. 15, 9 Sep 2020. Available from: URL: 803505526 http://doi.org/10.2217/imt-2020-0193

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Reactions 10 Oct 2020 No. 1825