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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 54-year-old man developed pancytopenia during treatment with cisplatin and gemcitabine for nasopharyngeal carcinoma [routes and dosages not stated].
The man, who had nasopharyngeal carcinoma with lung and bone metastasis, presented to hospital with one day history of dyspnoea, anorexia and fever. His last chemotherapy including cisplatin and gemcitabine, which were administered four days prior to presentation. He had various concurrent conditions including type 2 diabetes mellitus, rheumatoid arthritis and hypertension. His chronic medications were amlodipine, azathioprine, metformin and pantoprazole. On presentation, he was afebrile and his respiration and haemodynamics was stable. Laboratory findings and pulmonary CT scan were suggestive of concurrent COVID-19, which was confirmed with positive polymerase chain reaction for SARS-CoV-2 on nasopharyngeal swab. Blood tests showed anaemia, profound neutropenia and thrombocytopenia. Differential diagnosis included pancytopenia and neutropenic fever.
The man received treatment with piperacillin/tazobactam and hydroxychloroquine. On day 2 of admission, unspecified granulocyte colony-stimulating factors (G-CSF) was administered due to concern of chemotherapy induced pancytopenia. Further to discussion, chemotherapy-induced pancytopenia remained as the preferable diagnosis. On day 6 of admission, neutropenia resolved. He developed progressive respiratory failure with increasing oxygen demand one day later. Repeat pulmonary CT scan revealed severe acute respiratory distress syndrome (ARDS) secondary to COVID-19. The lab findings were suggestive of a paradoxical immune reconstitution inflammatory syndrome (IRIS) attributed to unspecified granulocyte colony-stimulating factors (G-CSF) [specific drug not stated]. He received unspecified corticosteroid therapy and recovered rapidly within eight days.
Reference
- Mertens J, et al. A case of steroid-responsive, COVID-19 immune reconstitution inflammatory syndrome following the use of granulocyte colony-stimulating factor. Open Forum Infectious Diseases 7: no pagination, No. 8, Aug 2020. Available from: URL: 10.1093/ofid/ofaa326 [DOI] [PMC free article] [PubMed]