A patient with SARS-CoV-2 infection dies after a diagnosis of leukemia which hampered the clinical recovery and led to sepsis and multi-organ failure.
A 68-year-old male, ex-smoker, presented with a 10-day history of fever, cough, and progressive shortness of breath. His family physician prescribed him clarithromycin and anti-viral treatment (oseltamivir). However, there was no improvement. Serological investigations including arterial blood gases revealed acute respiratory failure. Chest X-ray revealed multiple diffuse infiltrates. The doctors shifted the patient to the intensive care unit with suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Moreover, a pharyngeal swab for Polymerase Chain Reaction (rt-PCR) confirmed SARS-CoV-2, confirming the diagnosis of COVID-19. None of his family members tested positive for COVID-19. His past medical history revealed diabetes mellitus and mild hypertension controlled with candesartan-hydrochlorothiazide. His lab results from one year back were all normal.
The patient was receiving recombinant tissue plasminogen activator (rt-PA) and tocilizumab. Moreover, during hospitalization, he developed candidemia and his blood cultures also revealed Stenotrophomonas maltophilia and Pseudomonas aeruginosa. He received broad-spectrum antifungal and antibiotic treatments.
Three days after the completion of tocilizumab, His serology revealed anti-SARS-CoV-2 IgG antibodies. Moreover, PCR for SARS-CoV-2 was negative. Despite this, his clinical condition worsened. Furthermore, his lab results showed sustained anaemia and thrombocytopenia. This gave rise to the suspicion of secondary bacterial infection and secondary hemophagocytic syndrome.
Therefore, the treating physician performed a bone marrow aspiration which unexpectedly identified 32% myeloblasts. After immunophenotyping a diagnosis of acute myeloid leukemia (AML) was confirmed.
Since, the patient’s clinical condition was poor and worsening, no chemotherapy was applied. Unfortunately, 2 days later, the patient died due to sepsis and multi-organ failure.
Source: Papamichalis P, Tsinti G, Papapostolou E, et al. (April 14, 2021) Newly Diagnosed Acute Myeloid Leukemia in a Patient With Severe SARS-CoV-2 Infection. Cureus 13(4): e14480. doi:10.7759/cureus.14480