Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4859-4865
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4859
Low symptomatic COVID-19 in an elderly patient with follicular lymphoma treated with rituximab-based immunotherapy: A case report
Stanisław Łącki, Kinga Wyżgolik, Michał Nicze, Sylwia Georgiew-Nadziakiewicz, Jerzy Chudek, Kamil Wdowiak
Stanisław Łącki, Kinga Wyżgolik, Michał Nicze, Jerzy Chudek, Kamil Wdowiak, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice 40-027, Silesian Voivodeship, Poland
Sylwia Georgiew-Nadziakiewicz, Imaging and Isotope Diagnostics Department, Chorzów General Hospital, Chorzów 41-500, Silesian Voivodeship, Poland
Author contributions: Chudek J and Wdowiak K collected the clinical data; Wyżgolik K, Nicze M and Łącki S designed the case report, reviewed the literature and drafted the manuscript; Georgiew-Nadziakiewicz S performed and interpreted the positron emission tomography-computed tomography imaging; Chudek J and Wdowiak K critically reviewed the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stanisław Łącki, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Reymonta 8, Katowice 40-027, Silesian Voivodeship, Poland. s.lacki@outlook.com
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: April 4, 2021
Revised: April 13, 2021
Accepted: May 6, 2021
Article in press: May 6, 2021
Published online: June 26, 2021
Abstract
BACKGROUND

Follicular lymphoma is an indolent lymphoma that may progress to a highly aggressive form requiring immunochemotherapy. Most regimens utilize rituximab, an anti-CD20 monoclonal antibody, which may affect the clinical course of novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections [coronavirus disease 2019 (COVID-19)]. Here we describe the first case of mild COVID-19 during ongoing oncological treatment without significant deterioration after rituximab administration.

CASE SUMMARY

A 74-year-old female with an enlargement of her right palatine tonsil was diagnosed with follicular lymphoma following tonsillectomy and started immunochemotherapy according to the rituximab, cyclophosphamide, vincristine, prednisone regimen. At home before the fourth cycle, she developed nonspecific symptoms (excessive fatigue, loss of appetite and nausea), misdiagnosed as adverse effects of chemotherapy. Unexpectedly, interim positron emission tomography-computed tomography scan, performed shortly before rituximab administration, revealed previously nonexistent pulmonary changes, potentially of infectious etiology. SARS-CoV-2 infection was confirmed by a nasopharyngeal swab (with reverse transcriptase polymerase chain reaction test) performed the following day. Despite rituximab infusion, the patient remained oligosymptomatic and was discharged home for self-isolation. Having reached a negative SARS-CoV-2 status before the subsequently scheduled regimen, the patient successfully received six cycles of rituximab, cyclophosphamide, vincristine, prednisone and obtained complete remission by positron emission tomography-computed tomography.

CONCLUSION

Our case shows that rituximab-based immunotherapy due to follicular lymphoma may have no evident negative effect on the COVID-19 clinical course.

Keywords: COVID-19, SARS-CoV-2, Follicular lymphoma, Rituximab, Case report

Core Tip: Follicular lymphoma is an indolent lymphoma requiring immunochemotherapy with rituximab. This anti-CD20 monoclonal antibody depletes malignant and normal B-cells, resulting in a significantly increased risk of infectious complications, including the novel coronavirus, severe acute respiratory syndrome coronavirus 2 infection [coronavirus disease 2019 (COVID-19)]. We present the first case of mild COVID-19 in an elderly patient during ongoing follicular lymphoma treatment, without significant deterioration after rituximab administration. This case highlights that rituximab-based therapy may have no evident negative effect on the clinical course of COVID-19 in patients with follicular lymphoma, which may be significant during the current pandemic.