Recovery from COVID-19 in a Child with Chronic Granulomatous Disease and T Cell Lymphopenia
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LETTER TO EDITOR
Recovery from COVID-19 in a Child with Chronic Granulomatous Disease and T Cell Lymphopenia Vasudha Mantravadi 1 & Suong T. Nguyen 2 & S. Celeste Morley 2 & Jeffrey J. Bednarski 3 & Maleewan Kitcharoensakkul 1,4 & Megan A. Cooper 4 Received: 14 September 2020 / Accepted: 18 October 2020 # The Author(s) 2020
Keywords Chronic granulomatous disease . COVID-19 . immunodeficiency
To the Editor: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), first discovered in December 2019, has led to an ongoing, unprecedented global pandemic due to coronavirus disease 2019 (COVID-19). This novel single-stranded RNA virus infects airway epithelial and other cell types expressing surface angiotensin-converting enzyme 2, with clinical manifestations ranging from asymptomatic infection to acute respiratory distress syndrome and severe organ dysfunction [1, 2]. Symptom onset is typically between 4 to 12 days of incubation. Older age and co-morbidities such as cancer, diabetes, and cardiovascular disease increase the risk for more severe disease, and a hyper-inflammatory response to the virus plays a key role in the multi-organ damage that is seen in severe cases [3]. Case reports of patients with inborn errors of immunity (IEI) suggest that the presence of B cells may contribute to immunopathology compared to a milder course in patients lacking B cells [4, 5]. A larger international retrospective cohort reported the clinical course of 94 patients with IEI,
* Megan A. Cooper [email protected] 1
Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
2
Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA
3
Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA
4
Department of Pediatrics, Division of Rheumatology/Immunology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA
primarily adults, with approximately 30% of patients having asymptomatic or mild infection, and major risk factors for disease severity including co-morbidities also present in the general population, with a fatality rate of ~ 10% [6]. This cohort included 4 patients with chronic granulomatous disease (CGD), 3 of whom did well, while one patient with concomitant Burkholderia infection died. Interrogation of the immune response in patients with severe COVID-19 has also revealed the importance of the type I interferon (IFN) pathway in controlling infection, including loss-of-function variants in genes in this pathway and neutralizing antibodies to type I IFNs [7, 8]. Here, we present the case of COVID-19 in a patient with CGD and T cell deficiency due to failed hematopoietic cell transplantation (HCT) who recovered with supportive care. The patient is a 12-month-old African-American boy with X-linked CGD due to a missense variant in CYBB, who had undergone allogeneic hematopo
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