Introduction
We present a case of a 51-year-old male with hypogammaglobulinemia and COVID-19 infection.
Case Description
A 51-year-old male with hypogammaglobulinemia secondary to a history of diffuse large B-cell lymphoma treated with R-CHOP, presented to the ED after 3 weeks of fevers, myalgias and dyspnea in the setting of known COVID-19 infection. Labs revealed low IgG (despite IVIg infusion 3 days prior), elevated D-dimer, CRP, and a low lymphocyte count which was normal 1 month prior. Chest x-ray showed hazy bilateral opacities concerning for atypical or viral pneumonia. On admission he required supplemental oxygen. He received IVIg (500 mg/kg), was started on therapeutic anticoagulation and enrolled into a clinical trial, which randomized giving hydroxychloroquine versus placebo. Throughout his hospital course he received convalescent plasma and two doses of methylprednisolone, meanwhile his oxygen requirements remained high. On day 12 of admission, he was found with abdominal pain and severe hypotension, and an abdominal/pelvic CT revealed a new retroperitoneal bleed. He required intubation, ICU-level care, initiation of vasopressors and a massive transfusion protocol. Despite these measures, he rapidly decompensated approximately 45 days after initial diagnosis and died.
Discussion
Fill et al hypothesized a cell-mediated response as being more important than a humoral response. Maybe our patient’s earlier history of malignancy, specifically having developed DLCBL, disrupted his T-cell response beyond ability in fighting against COVID-19. Additionally, the benefits of the treatments he received have not yet been fully demonstrated. As further studies and understanding emerges, hopefully more answers will be provided.