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Corticosteroids/immunosuppressants Coronavirus disease 2019: case report

A 17-year-old girl developed coronavirus disease-2019 (COVID-19) while receiving conditioning regimen with immunosuppressive drugs fludarabine, busulfan, ciclosporin, prednisolone and unspecified corticosteroids [routes not stated; not all dosages stated]. The girl underwent haematopoietic stem cell transplantation in France on 07 January 2020 for acute myeloid leukaemia. She had been receiving conditioning regimen with fludarabine, busulfan and ciclosporin [cyclosporine] for the prevention of graft-versushost disease (GVHD). She developed cutaneous and digestive GVHD for which she received unspecified corticosteroids. On 24 March 2020, she was tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of multiple suspected cases in her family. She presented with rhinitis. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swab specimens was positive for SARS-CoV-2. At that time, she had been receiving prednisolone 0.4 mg/kg/day for her digestive GVHD, ciclosporin 4 mg/kg/day and other concomitant medications including unspecified ACE inhibitors. Complete blood count revealed the following: average haematological reconstitution, pre-existing lymphopenia, haemoglobin 96 g/L and platelets 53 × 109/L. Cytokines were in normal range. On 31 March 2020, chest CT demonstrated scattered ground glass opacities in her right lower lobe consistent with COVID-19 [duration of treatment to reaction onset not stated]. After 1 month, a fibrosis aspect was reported as a usual evolution of COVID-19. The RT-PCR on nasopharyngeal swab specimen was still positive for SARS-CoV-2 following 21 days and 42 days of initial positive test. On day 56 following initial positive test, the RT-PCR was negative for SARSCoV-2. Serology tests showed no development of IgA, IgM or IgG on day 7. On day 14, IgM antibody was detected, which remained weakly positive on day 56. On day 56, IgG antibody was positive. Her risk factors for the development of COVID-19 included postallograft immunosuppression, corticosteroid therapy, underlying cardiomyopathy, underlying GVHD and underlying lymphopenia. Nazon C, et al. Coronavirus disease 2019 3 months after hematopoietic stem cell transplant: A pediatric case report. Pediatric Blood and Cancer 67: No. 9, Sep 2020. Available from: URL: http://doi.org/10.1002/pbc.28545

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Reactions 19 Sep 2020 No. 1822