Severe COVID-19 in Patients with B Cell Alymphocytosis and Response to Convalescent Plasma Therapy
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LETTER TO EDITOR
Severe COVID-19 in Patients with B Cell Alymphocytosis and Response to Convalescent Plasma Therapy Jonathan London 1 & David Boutboul 2,3 & Karine Lacombe 4 & France Pirenne 5 & Beate Heym 6 & Valérie Zeller 1 & Antoine Baudet 7 & Amani Ouedrani 8,9 & Alice Bérezné 7 Received: 9 July 2020 / Accepted: 28 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
To the Editor, The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. In most cases, COVID-19 is a self-limited infection but some patients will present with severe respiratory distress requiring intensive care unit admission and mechanical ventilation. The main risk factors for severe forms are older age, cardiovascular, and chronic pulmonary diseases [1]. The role of primary or acquired immune deficiencies (ID) in the onset of severe COVID-19 is still controversial. This could be explained by the great heterogeneity of ID, with variable risks depending on the ID subtype. The risk of developing a severe form of COVID-19 in patients with primary ID such as common variable immunodeficiency (CVID) or agammaglobulinemia is not known [2], Herein, we describe two patients with hypogammaglobulinemia and B cell alymphocytosis who presented with severe COVID-19 including a patient with a chronic viremic form that persisted after acute respiratory distress syndrome (ARDS) recovery and successfully treated with convalescent plasma.
* Jonathan London [email protected] * David Boutboul [email protected] 1
2
3
Department of Internal Medicine and Infectious diseases, Hôpital Diaconesses Croix Saint-Simon, 125 rue d’Avron, 75020 Paris, France Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France U976 HIPI, Insight team, Hôpital Saint-Louis, Université de Paris, Paris, France
Case 1 A 41-year-old woman was admitted to the hospital at the mid of the COVID-19 pandemic because of dyspnea, fever, headache, diarrhea, abdominal pain, ageusia, and anosmia that had been ongoing for 17 days. She had a medical history of breast implants and an anal horseshoe abscess and fistula treated surgically 6 months before with non-caseating granuloma found on histological examination. No other infections were reported. Her respiratory rate was 40/min and SpO2 was 89%. She received oxygen supplementation. Hydroxychloroquine (600 mg/day) was started and maintained for 10 days with ceftriaxone and spiramycin as local standard of care. Her nasopharyngeal swab tested positive for SARS-CoV-2. Laboratory tests showed lymphopenia (660/mm3) and elevated C-reactive protein (CRP) at 134 mg/L. Chest CT scan showed extensive infiltrates (50 to 75% of lungs involved) consistent with severe COVID-19 and a 10-cm right lower mediastinal mass. Two days later, her clinical condition worsened and Boussignac continuous positive airway pressure (CPAP) was s
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