Gammapatia Monoclonale E Infezione Da Sars-Cov-2

ABSTRACT

We report the clinical case of a 90-years-old woman with a history of arterial hypertension, hypothyroidism, obesity, and chronic obstructive pulmonary disease (COPD), who referred to our center (Pederzoli hospital, Peschiera del Garda, Verona, Italy) for dyspnea in January 2022 after tested positive for SARS-CoV-2 infection. The patient received primary vaccination with mRNA vaccine in October 2021. At the time of hospital admission, chest high resolution computed tomography (HRCT) revealed bilateral ground-glass opacities compatible with interstitial pneumonia. Blood tests revealed lymphopenia (0,7 10-3/ uL), iron (33 ug/dL) C-reactive protein (CRP) (28.1 mg/dL) and erythrocyte sedimentation rate (ESR) (79 mm). Treatment with oxygen therapy, steroids, and immunosuppressants (Baricitinib) was started. Two weeks after hospital discharge, during a routine examination, a totally unexpected alteration of the electrophoretic pattern was found on serum protein electrophoresis (SPEP) performed with Capillarys 2 (Sebia, Lisses, France). This alteration is visible as apeak in the g region and it was characterized as IgG-kappa by immunofixation performed with Hydrasys 2 (Sebia, Lisses, France). In this case, the unforeseen occurrence of such alteration in SPEP caught our attention because the patient had no previous evidence of monoclonal gammopathy, and her SPEP was normal in January 2022.A few studies describe the occurrence of a monoclonal spike in association with acute inflammatory illnesses, especially in viral infections. Considering that during severe COVID-19 there is a release of IL-6, which plays an important role in B-cells differentiation into plasma cells, a correlation could be hypothesized between the COVID 19 disease and the alteration in SPEP, without excluding the possible interference given by pharmacological therapy.In conclusion, our findings underline the need of further studies in order to evaluate the degree of immune hyperactivation in patients with severe COVID-19 and the prognostic role to improve the management of patients in this clinical setting.