ABSTRACT
RATIONALE: This case report demonstrates the use of flourine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) to rule out Richter transformation (RT) as the cause of clinical deterioration in a patient with chronic lymphatic leukemia (CLL) and severe COVID-19. 18F-FDG PET/CT can be used to establish the diagnosis of RT in patients with CLL, but the use of 18F-FDG PET/CT to exclude RT as the cause of clinical deterioration in patients with CLL and severe COVID-19 has not previously been described. PATIENT CONCERNS: A 61-year-old male with CLL and COVID-19 developed increased dyspnea, malaise and fever during hospitalization for treatment of severe and prolonged COVID-19. DIAGNOSES: 18F-FDG PET/CT ruled out RT and revealed progression of opacities in both lungs consistent with exacerbation of severe acute respiratory syndrome coronavirus 2 pneumonia. INTERVENTIONS: 18F-FDG PET/CT imaging. OUTCOMES: The patient was discharged at day 52 without the need of supplemental oxygen, with normalized infection marks and continued care for CLL with venetoclax. LESSONS: 18F-FDG PET/CT ruled out RT as the cause of deteriorations in a patient with CLL and severe COVID-19, enabling directed care of exacerbation of severe acute respiratory syndrome coronavirus 2 pneumonia.
Subject(s)
COVID-19 , Clinical Deterioration , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphoma, Large B-Cell, Diffuse , COVID-19/complications , Fluorodeoxyglucose F18 , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging , Male , Middle Aged , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , RadiopharmaceuticalsSubject(s)
Anemia, Hemolytic, Autoimmune , COVID-19 , Leukemia, Lymphocytic, Chronic, B-Cell , SARS-CoV-2/metabolism , Aged, 80 and over , Anemia, Hemolytic, Autoimmune/blood , Anemia, Hemolytic, Autoimmune/diagnostic imaging , Anemia, Hemolytic, Autoimmune/pathology , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/pathology , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/blood , Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymphocyte CountSubject(s)
COVID-19/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymphocytes/pathology , Lymphocytosis/pathology , SARS-CoV-2/pathogenicity , Aged, 80 and over , COVID-19/diagnostic imaging , COVID-19/immunology , COVID-19/virology , Clone Cells , Complementarity Determining Regions/genetics , Complementarity Determining Regions/immunology , Disease Progression , Gene Expression , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Leukemia, Lymphocytic, Chronic, B-Cell/virology , Lymphocytes/immunology , Lymphocytes/virology , Lymphocytosis/diagnostic imaging , Lymphocytosis/immunology , Lymphocytosis/virology , Male , Mutation , Remission, Spontaneous , SARS-CoV-2/immunology , Severity of Illness Index , Tomography, X-Ray Computed , Tumor Suppressor Protein p53/genetics , Tumor Suppressor Protein p53/immunologyABSTRACT
During this COVID-19 pandemic, patients with symptoms such as fever, cough, sore throat, and coryza were advised to have RT-PCR testing for SARS-CoV-2 infection. We described here an elderly female with chronic lymphocytic leukemia, who presented with atypical symptoms that were not directly attributable to COVID-19. This patient was admitted to the non-COVID-19 ward for supportive care. Later, her chest x-ray revealed pneumonia that was confirmed to be COVID-19 by RT-PCR testing several days later. In resource-poor settings where molecular testing results suffered from delays or were altogether unavailable, the use of diagnostic imaging such as a chest x-ray could serve as a quick guide in the assessment and management of these patients especially if the imaging results suggest COVID-19 infection.