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1.
Dermatol Online J ; 27(12)2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1789588

ABSTRACT

Primary cutaneous diffuse large B-cell lymphoma, leg type is a rare entity accounting for 4% of all primary cutaneous lymphomas whose clinical presentation encompasses a range of possibilities. COVID-19 has caused a delay in diagnosis of malignant neoplasms and consequently, this has resulted in poorer prognoses. A 62-year-old woman presented with two smooth-surfaced, mobile, well-circumscribed, oval, skin-colored nodules approximately one-cm in diameter with nonerythematous borders on the lower third of the left leg. Two months later, eleven nodules measuring between one and 1.5cm with erythematous halo, slight scaling, central erosion, and crusting had appeared. Histological study showed moderate pericapillary lymphocytic infiltration in the papillary and reticular dermis and prominent diffuse proliferation of medium to large cells in the subcutis. These exhibited irregular vesicular nuclei, a conspicuous solitary nucleolus of two to three small nucleoli, and three mitoses per high power field. Adipocytes were consistently encircled by neoplastic lymphocytes. Primary cutaneous diffuse large B-cell lymphoma, leg type is a high-grade lymphoma that can manifest as a diagnostic challenge and requires adequate immunohistochemistry and in situ hybridization studies for proper diagnosis, treatment, and prognosis.


Subject(s)
COVID-19 , Lymphoma, Large B-Cell, Diffuse , Panniculitis , Skin Neoplasms , COVID-19/diagnosis , Female , Humans , Leg/pathology , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, T-Cell , Middle Aged , Panniculitis/diagnosis , Panniculitis/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology
2.
Infect Dis (Lond) ; 54(7): 529-533, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1764477

ABSTRACT

BACKGROUND: The global spread of SARS-CoV-2 has necessitated case isolation, with recommended isolation times based on mean time to viral clearance. CASE STUDY: We present a 28-year-old female living with vertically acquired HIV, undergoing chemotherapy for lymphoma who tested SARS-CoV-2-PCR positive for 164 days. The patient had a history of difficulty taking ARVs, with detectable HIV-RNA and CD4 count below 200 × 106 for the 8 years prior to presentation with symptoms. She stopped ARVs 10 months prior to experiencing fevers, night sweats and loose stool, with a viral load of 354,000 copies/ml and CD4 count of 30 × 106. Following no yield on basic investigations, positron emission tomography scan showed diffuse colonic and oesophageal avidity and a caecal biopsy showed diffuse large B-cell lymphoma. She re-started ARVs and underwent five cycles of R-CHOP chemotherapy. Her first positive SARS-CoV-2 PCR test was detected through routine asymptomatic screening. She self-isolated due to repeated positive tests on a further 8 swabs for a total of 164 days until a negative PCR test. She reported feeling low in mood and frustrated by repeated positive tests and the associated lack of social contact or ability to work. Her positive tests prevented in-person review by her HIV team, which impacted her ARV adherence leading to an unplanned break in therapy. CONCLUSIONS: Our case highlights the challenges to physical and mental health faced by patients with prolonged SARS-CoV-2 shedding and the need to develop surrogate markers for infectivity to enable prompt medical and psychological support and accurate advice about the need for isolation.


Subject(s)
COVID-19 , HIV Infections , Lymphoma, Large B-Cell, Diffuse , Adult , Female , HIV Infections/complications , HIV Infections/drug therapy , Humans , Lymphoma, Large B-Cell, Diffuse/drug therapy , SARS-CoV-2 , Viral Load , Virus Shedding
3.
Medicine (Baltimore) ; 100(44): e27545, 2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1570144

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 , Radiopharmaceuticals
4.
J Med Virol ; 94(1): 417-423, 2022 01.
Article in English | MEDLINE | ID: covidwho-1439701

ABSTRACT

A 36-year-old male with diffuse large B-cell lymphoma on maintenance rituximab therapy presented to the emergency department with high fever and fatigue. A chest X-ray showed a lobar infiltrate, 40 days before admission the patient suffered from a mild coronavirus disease 2019 (COVID-19) infection and fully recovered. PCR nasopharyngeal swab was negative for COVID-19. Comprehensive biochemical, radiological, and pathological evaluation including 18-fluorodeoxyglucose positron emission tomography with computed tomography and transbronchial lung biopsy found no pathogen or lymphoma recurrence. Treatment for pneumonia with antibiotic and antifungal agents was nonbeneficial. A diagnosis of secondary organizing pneumonia (OP) was made after pneumonia migration and a rapid response to corticosteroids. OP secondary to a viral respiratory infection has been well described. Raising awareness for post-COVID-19 OP has therapeutic and prognostic importance because those patients benefit from steroid therapy. We believe the condition described here is underdiagnosed and undertreated by doctors worldwide. Because of the ongoing global pandemic we are now encountering a new kind of patient, patients that have recovered from COVID-19. We hope that this case may contribute to gaining more knowledge about this growing patient population.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/therapy , Cryptogenic Organizing Pneumonia/diagnosis , Cryptogenic Organizing Pneumonia/drug therapy , Adult , Antineoplastic Agents, Immunological/therapeutic use , Cryptogenic Organizing Pneumonia/pathology , Humans , Immunocompromised Host/immunology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Male , Nasopharynx/virology , Positron-Emission Tomography , Rituximab/therapeutic use , SARS-CoV-2
5.
J Investig Med High Impact Case Rep ; 9: 23247096211041207, 2021.
Article in English | MEDLINE | ID: covidwho-1370934

ABSTRACT

As more patients recover from COVID-19 infection, long-term complications are beginning to arise. Our case report will explore a debilitating long-term complication, Post-COVID Interstitial Lung Disease (PC-ILD). We will introduce a patient who developed PC-ILD in the setting of diffuse large B-cell lymphoma, outlining a difficult hospital course, including a positive COVID-19 polymerase chain reaction (PCR) for more than 3 months. We will then discuss the human body's physiological response to the virus and how our patient was not able to adequately mount an immune response. Finally, the pathophysiology of PC-ILD will be explored and correlated with the patient's subsequent computed tomographic images obtained over a 3-month period. The difficult hospital course and complex medical decision-making outlined in this case report serve as a reminder for health care providers to maintain vigilance in protecting our most vulnerable patient population from such a devastating disease process.


Subject(s)
COVID-19/complications , Immunocompromised Host , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/virology , Lymphoma, Large B-Cell, Diffuse/complications , SARS-CoV-2/pathogenicity , Aged , COVID-19/virology , Humans , Lymphoma, Large B-Cell, Diffuse/immunology , Male , SARS-CoV-2/immunology
6.
Future Oncol ; 17(33): 4511-4525, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1367736

ABSTRACT

Aim: To understand the economic burden of relapsed and refractory large B-cell lymphoma patients in Japan treated with salvage chemotherapy. Patients & methods: Patients who received systemic therapy after first-line treatment were analyzed to assess its associated cost and resource use using a retrospective claims database. The impact of COVID-19 was assessed separately. Results & conclusion: This study identified 2927 and 1085 patients in the second- (2L) and third-line (3L) cohorts. The median ages for the 2L and 3L cohorts were 71 and 70 years, respectively, with Charlson Comorbidity Score of 3. A majority of the patients had limited stem cell transplant due to advanced age. Median lengths of inpatient stay for the 2L and 3L cohorts were 118 and 116 days, respectively. The majority of costs were attributed to inpatient costs, and limited COVID-19 impact was observed in this study.


Subject(s)
COVID-19/prevention & control , Cost of Illness , Lymphoma, Large B-Cell, Diffuse/economics , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/economics , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Female , Humans , Japan/epidemiology , Length of Stay/economics , Length of Stay/statistics & numerical data , Lymphoma, Large B-Cell, Diffuse/epidemiology , Lymphoma, Large B-Cell, Diffuse/therapy , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Retrospective Studies , Salvage Therapy/economics , Salvage Therapy/methods , Stem Cell Transplantation/economics , Stem Cell Transplantation/statistics & numerical data
7.
Front Immunol ; 12: 711915, 2021.
Article in English | MEDLINE | ID: covidwho-1317228

ABSTRACT

Passive antibody therapy has been used to treat outbreaks of viral disease, including the ongoing pandemic of severe respiratory acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) or COVID-19. However, the real benefits of the procedure are unclear. We infused a concentrated solution of neutralizing anti-SARS-CoV-2 antibodies obtained from a convalescent donor with a single session of double filtration plasmapheresis (DFPP) into a 56-year-old woman with long history of unremitting, severe COVID-19. She was unable to establish an adequate antiviral immune response because of previous chemotherapy, including the infusion of the anti-CD20 monoclonal antibody rituximab, administered to treat a diffuse large B-cell lymphoma. The disease promptly recovered despite evidence of no endogenous anti-SARS-CoV-2 antibody production. The observation that passive antibody therapy might prove particularly effective in immunodepressed COVID-19 patients requires evaluation in prospective randomized controlled trial.


Subject(s)
Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/therapeutic use , COVID-19/therapy , Immunization, Passive/methods , Immunocompromised Host , Immunoglobulin G/therapeutic use , Plasmapheresis/methods , SARS-CoV-2/genetics , Antineoplastic Agents, Immunological/adverse effects , Antiviral Agents/therapeutic use , COVID-19/immunology , COVID-19/virology , Female , Humans , Immunity/drug effects , Lymphoma, Large B-Cell, Diffuse/drug therapy , Middle Aged , RNA, Viral/genetics , Rituximab/adverse effects , Treatment Outcome
9.
Transfus Clin Biol ; 28(3): 264-270, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1201297

ABSTRACT

OBJECTIVES: The patients with hematological malignancies are a vulnerable group to COVID-19, due to the immunodeficiency resulting from the underlying disease and oncological treatment that significantly impair cellular and humoral immunity. Here we report on a beneficial impact of a passive immunotherapy with convalescent plasma to treat a prolonged, active COVID-19 infection in a patient with a history of nasopharyngeal diffuse large B-cell lymphoma treated with the therapy inducing substantial impairment of particularly humoral arm of immune system. The specific aim was to quantify SARS-CoV2 neutralizing antibodies in a patient plasma during the course of therapy. MATERIALS AND METHODS: Besides the standard of care treatment and monitoring, neutralizing antibody titers in patient's serum samples, calibrated according to the First WHO International Standard for anti-SARS-CoV-2 immunoglobulin (human), were quantified in a time-dependent manner. During the immunotherapy period peripheral blood flow cytometry immunophenotyping was conducted to characterize lymphocyte subpopulations. RESULTS: The waves of clinical improvements and worsening coincided with transfused neutralizing antibodies rises and drops in the patient's systemic circulation, proving their contribution in controlling the disease progress. Besides the patient's lack of own humoral immune system, immunophenotyping analysis revealed also the reduced level of helper T-lymphocytes and immune exhaustion of monocytes. CONCLUSION: Therapeutic approach based on convalescent plasma transfusion transformed a prolonged, active COVID-19 infection into a manageable chronic disease.


Subject(s)
Antibodies, Viral/biosynthesis , COVID-19/therapy , Immunocompromised Host , Lymphoma, Large B-Cell, Diffuse/complications , SARS-CoV-2/immunology , Animals , Antibodies, Neutralizing/blood , Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/blood , Antibodies, Viral/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , COVID-19/complications , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Chlorocebus aethiops , Combined Modality Therapy , Hematopoietic Stem Cell Transplantation , Humans , Immunization, Passive , Immunophenotyping , Lymphocyte Subsets/drug effects , Lymphocyte Subsets/immunology , Lymphoma, Large B-Cell, Diffuse/immunology , Lymphoma, Large B-Cell, Diffuse/therapy , Lymphopenia/etiology , Lymphopenia/immunology , Male , Middle Aged , Monocytes/immunology , Nasopharynx/virology , RNA, Viral/analysis , RNA, Viral/blood , Radiotherapy, Adjuvant , Rituximab/administration & dosage , Rituximab/adverse effects , SARS-CoV-2/isolation & purification , Vero Cells , Virus Cultivation
12.
BMJ Case Rep ; 14(1)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1054637

ABSTRACT

Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.


Subject(s)
Airway Obstruction/etiology , Anesthesia/methods , COVID-19/prevention & control , Lymphoma, Large B-Cell, Diffuse/complications , Nasopharyngeal Neoplasms/surgery , Tracheostomy/methods , Acute Disease , Airway Obstruction/surgery , Anesthesia, General , Anesthesia, Local , Anesthetists , Diagnosis, Differential , Female , Humans , Laryngoscopy/methods , Lung/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/surgery , Middle Aged , Nasopharyngeal Neoplasms/complications , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharynx/diagnostic imaging , Nasopharynx/surgery , Radiography/methods , SARS-CoV-2
14.
Chemotherapy ; 65(5-6): 161-165, 2020.
Article in English | MEDLINE | ID: covidwho-1039939

ABSTRACT

Eleven years ago, a 64-year-old Caucasian man had LNH Follicular 3a, IV A stage, FLIPI 2 as a prognostic index of follicular lymphoma. He received 8 cycles of RCHOP followed by rituximab maintenance, with complete remission. Due to a systemic recurrence, a new treatment schedule (RCOMP, 6 cycles) was introduced with partial remission persisting during a long-term maintenance treatment with rituximab. Three years ago, LNH Follicular 3a progressed into GC type diffuse large B-cell lymphomas (DLBCL); 6 cycles of rituximab and bendamustine were followed by R-ICE and R OXALI DHAP treatments without beneficial effect. Due to the worse general condition (ECOG 3-4), the patient was treated with pixantrone (6 cycles) until July 10, 2019, with a partial response. On Jan 13, 2020, an extreme compassioned treatment with venetoclax alone was started; this drug was well tolerated and provided a satisfactory clinical and laboratory improvement. In June 2020, however, he developed bone marrow toxicity and septic fever. Nasal and pharyngeal secretions were SARS-CoV-2 RNA negative. Blood cultures for mycotic agents and Gram-positive, Gram-negative, and anaerobic bacteria were negative, but few days later, the patients died of sepsis due to unidentified agents. The use of venetoclax as a single drug to treat DLBCL BCL2 patients deserves further investigation.


Subject(s)
Bridged Bicyclo Compounds, Heterocyclic/therapeutic use , Lymphoma, Large B-Cell, Diffuse/drug therapy , Sulfonamides/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Humans , Male , Middle Aged
16.
Br J Haematol ; 191(3): 386-389, 2020 11.
Article in English | MEDLINE | ID: covidwho-697165

ABSTRACT

The COVID-19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS-CoV-2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high-grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS-CoV-2 infection while continuing haematological treatment. In this report, we analyse the management of front-line therapy in 18 patients during the COVID-19 outbreak, as well as the results of the implemented measures in their outcome.


Subject(s)
COVID-19/epidemiology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Pandemics , Plasmablastic Lymphoma/drug therapy , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , Bacterial Infections/complications , Bacterial Infections/drug therapy , COVID-19/complications , COVID-19/drug therapy , COVID-19/prevention & control , COVID-19 Testing , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Febrile Neutropenia/chemically induced , Febrile Neutropenia/prevention & control , Female , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Infection Control/methods , Male , Middle Aged , Prednisone/administration & dosage , Prednisone/adverse effects , Rituximab/administration & dosage , Spain/epidemiology , Superinfection/drug therapy , Vincristine/administration & dosage , Vincristine/adverse effects
17.
Br J Haematol ; 190(2): 185-188, 2020 07.
Article in English | MEDLINE | ID: covidwho-626838

ABSTRACT

SARS-CoV-2 infection can cause severe pneumonia (COVID-19). There is evidence that patients with comorbidities are at higher risk of a severe disease course. The role of immunosuppression in the disease course is not clear. In the present report, we first describe two cases of persisting SARS-CoV-2 viraemia with fatal outcome in patients after rituximab therapy.


Subject(s)
Coronavirus Infections/pathology , Pneumonia, Viral/pathology , Rituximab/administration & dosage , Viremia/diagnosis , Aged , B-Lymphocytes/pathology , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Fatal Outcome , Humans , Immunocompromised Host , Lymphoma, Large B-Cell, Diffuse/complications , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Mantle-Cell/complications , Lymphoma, Mantle-Cell/drug therapy , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2
18.
Clin Nucl Med ; 45(8): e383-e385, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-590994

ABSTRACT

The incidence of COVID-19, a severe acute respiratory syndrome caused by SARS-CoV-2, is rapidly growing worldwide. In this pandemic period, the chance of incidental pulmonary findings suggestive of COVID-19 at F-FDG PET/CT in asymptomatic oncological patients is not negligible. To suspect COVID-19 is more demanding whether its presentation is atypical. We describe the incidental PET/CT detection of an F-FDG-avid isolated centrilobular pulmonary consolidation in an asymptomatic lymphoma patient, which later resulted in an unexpected and atypical COVID-19 presentation. The nuclear medicine physicians should be prepared to suspect COVID-19 even in asymptomatic patients presenting with a "far-from-COVID-19" finding at PET/CT.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/complications , Pneumonia, Viral/diagnostic imaging , COVID-19 , Coronavirus Infections/complications , Fluorodeoxyglucose F18 , Humans , Lung , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Positron Emission Tomography Computed Tomography , SARS-CoV-2
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