Severe COVID-19 virus reactivation following treatment for B cell acute lymphoblastic leukemia
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LETTER TO THE EDITOR
Severe COVID‑19 virus reactivation following treatment for B cell acute lymphoblastic leukemia Guido Lancman, John Mascarenhas and Michal Bar‑Natan*
Abstract SARS-CoV-2 has infected millions of people worldwide, but little is known at this time about second infections or reactivation. Here, we report a case of a 55-year-old female undergoing treatment for CD20+ B cell acute lymphoblas‑ tic leukemia who experienced a viral reactivation after receiving rituximab, cytarabine, and dasatinib. She was initially hospitalized with COVID-19 in April and developed a high antibody titer with two negative nasal polymerase chain reaction (PCR) swabs for SARS-CoV-2 on discharge. After recovery, she resumed treatment in June for her leukemia, which included rituximab, cytarabine, and dasatinib. She promptly lost her COVID-19 antibodies, and her nasal PCR turned positive in June. She developed a severe COVID-19 pneumonia with lymphopenia, high inflammatory mark‑ ers, and characteristic bilateral ground-glass opacities on chest CT, requiring high-flow nasal cannula and transfer to the intensive care unit. She received steroids, anticoagulation, and convalescent plasma, and within 48 h she was off oxygen. She was discharged home in stable condition several days later. Given the short time frame from leukemia treatment to PCR positivity and the low case rate in mid-June in New York City, reinfection appears to have been unlikely and SARS-CoV-2 reactivation is a possible explanation. This case illustrates the risks of treating recently recov‑ ered COVID-19 patients with immunosuppressive therapy, particularly lymphocyte- and antibody-depleting therapy, and raises new questions about the potential of SARS-CoV-2 reactivation. Keywords: COVID-19, SARS-CoV-2, Reactivation, Rituximab, Cytarabine To the editor SARS-CoV-2 has currently infected over 10 million people worldwide with over 500,000 deaths. However, little is known about reactivation of SARS-CoV-2. Although positive polymerase chain reaction (PCR) for SARS-CoV-2 following two negative PCR tests has been reported in up to 14–21% of patients [1, 2], these new positive tests occurred within 30 days of the last negative test and were thought to represent prior false negative PCR results and the consequence of prolonged viral shedding. There are sporadic reports to date of clinical COVID-19 virus reactivation. Ye et al. reported 5 patients with clinical *Correspondence: Michal.Bar‑[email protected] Tisch Cancer Institute, Icahn School of Medicine At Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, USA
reactivation presenting mostly with fatigue and fever, but none of them developed severe COVID-19 pneumonia or died [3]. Ravioli et al. reported two elderly patients who developed COVID-19, recovered and tested negative by PCR, and then developed a new COVID-19 pneumonia, with one patient dying and the other remaining hospitalized at the time of the report [4]. Here, we report a case of severe COVID-19 virus reactivation following chemotherapy, in
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