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Original article

Vol. 150 No. 1516 (2020)

Benign COVID-19 in an immunocompromised cancer patient – the case of a married couple

  • Valentina Spezzani
  • Alessio Piunno
  • Hans-Ulrich Iselin
DOI
https://doi.org/10.4414/smw.2020.20246
Cite this as:
Swiss Med Wkly. 2020;150:w20246
Published
11.04.2020

Summary

Respiratory failure in COVID-19 is a common feature in fatal cases and has been considered as a failure of the immune system to control the virus. Here we report the case of COVID-19 affecting an immunocompromised women and her presumably immunocompetent spouse. A married couple (age 60 years) was simultaneously admitted to the emergency department on 10 March 2020 because of dyspnoea and fever, consistent with COVID-19. The wife (patient 1) was partially immunocompromised as a consequence of a recently started chemotherapy with fulvestrant and abemaciclid for recurring breast cancer, her husband (patient 2) had been healthy except for a history of controlled arterial hypertension. Both patients were treated with darunavir/cobicistat and hydroxychloroquine. The clinical course of the immunocompromised partner was benign, without need of intensive care. She was able to leave the hospital on day 6 after admission. In contrast, her husband needed intensive care and his recovery was slow, although eventually successful too. These findings suggest that the course of COVID-19 is not necessarily ominous in the presence of a compromised immune response and tend to reinforce the emerging therapeutic concepts of a controlled mitigation of the immune cascade following SARS CoV-2 infection.

References

  1. The SARS Epidemic and its Aftermath in China - A Political Perspective. In: Learning from SARS: Preparing for the Next Disease Outbreak. Washington DC: National Academies Press (US); 2004.
  2. Li CK Wu H Yan H Ma S Wang L Zhang M T cell responses to whole SARS coronavirus in humans. J Immunol. 2008;181(8):5490–500. doi:.https://doi.org/10.4049/jimmunol.181.8.5490
  3. Peiris JS Chu CM Cheng VC Chan KS Hung IF Poon LL HKU/UCH SARS Study Group. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361(9371):1767–72. doi:.https://doi.org/10.1016/S0140-6736(03)13412-5
  4. Dandekar AA Perlman S. Immunopathogenesis of coronavirus infections: implications for SARS. Nat Rev Immunol. 2005;5(12):917–27. doi:.https://doi.org/10.1038/nri1732
  5. Frieman M Baric R. Mechanisms of severe acute respiratory syndrome pathogenesis and innate immunomodulation. Microbiol Mol Biol Rev. 2008;72(4):672–85. doi:.https://doi.org/10.1128/MMBR.00015-08
  6. Gralinski LE Sheahan TP Morrison TE Menachery VD Jensen K Leist SR Complement Activation Contributes to Severe Acute Respiratory Syndrome Coronavirus Pathogenesis. MBio. 2018;9(5):e01753-18. doi:.https://doi.org/10.1128/mBio.01753-18
  7. Mehta P McAuley DF Brown M Sanchez E Tattersall RS Manson JJ HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–4. doi:.https://doi.org/10.1016/S0140-6736(20)30628-0
  8. Ferrara JL Abhyankar S Gilliland DG. Cytokine storm of graft-versus-host disease: a critical effector role for interleukin-1. Transplant Proc. 1993;25(1 Pt 2):1216–7.
  9. The Johns Hopkins University. Johns Hopkins ABX Guide: Coronavirus COVID-19 (SARS-CoV-2). 2020. Available at: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_
  10. Colson P Rolain JM Lagier JC Brouqui P Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents. 2020:105932. doi:.https://doi.org/10.1016/j.ijantimicag.2020.105932
  11. A Randomized, Open, Controlled Trial for Darunavir/Cobicistat or Lopinavir/Ritonavir combined with Thymosin A1 in the Treatment of Novel Coronavirus Pneumonia. 2020.
  12. Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci Trends. 2020;14(1):69–71. doi:.https://doi.org/10.5582/bst.2020.01020
  13. Agostini ML Andres EL Sims AC Graham RL Sheahan TP Lu X Coronavirus Susceptibility to the Antiviral Remdesivir (GS-5734) Is Mediated by the Viral Polymerase and the Proofreading Exoribonuclease. MBio. 2018;9(2):e00221-18. doi:.https://doi.org/10.1128/mBio.00221-18
  14. Xia S Yan L Xu W Agrawal AS Algaissi A Tseng CK A pan-coronavirus fusion inhibitor targeting the HR1 domain of human coronavirus spike. Sci Adv. 2019;5(4):eaav4580. doi:.https://doi.org/10.1126/sciadv.aav4580
  15. Boriskin YS Leneva IA Pécheur EI Polyak SJ. Arbidol: a broad-spectrum antiviral compound that blocks viral fusion. Curr Med Chem. 2008;15(10):997–1005. doi:.https://doi.org/10.2174/092986708784049658
  16. Xia J Rong L Sawakami T Inagaki Y Song P Hasegawa K Shufeng Jiedu Capsule and its active ingredients induce apoptosis, inhibit migration and invasion, and enhances doxorubicin therapeutic efficacy in hepatocellular carcinoma. Biomed Pharmacother. 2018;99:921–30. doi:.https://doi.org/10.1016/j.biopha.2018.01.163
  17. Wang CH Zhong Y Zhang Y Liu JP Wang YF Jia WN A network analysis of the Chinese medicine Lianhua-Qingwen formula to identify its main effective components. Mol Biosyst. 2016;12(2):606–13. doi:.https://doi.org/10.1039/C5MB00448A
  18. Al-Bari MA. Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases. J Antimicrob Chemother. 2015;70(6):1608–21. doi:.https://doi.org/10.1093/jac/dkv018
  19. Zhou D Dai S-M Tong Q. COVID-19: a recommendation to examine of hydrochloroquine in preventing infection and progression. J Antimicrob Chemother. 2020;dkaa114. doi:.https://doi.org/10.1093/jac/dkaa114
  20. Efficacy and Safety of Darunavir and Cobicistat for Pneumonia Caused by 2019-nCoV (DACO-nCoV). 2020.
  21. Matsuyama S The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15. bioRxiv. 2020.
  22. Rodrigues JCL Hare SS Edey A Devaraj A Jacob J Johnstone A An update on COVID-19 for the radiologist - A British society of Thoracic Imaging statement. Clin Radiol. 2020;75(5):323–5. doi:.https://doi.org/10.1016/j.crad.2020.03.003
  23. Kaysin A Viera AJ. Community-Acquired Pneumonia in Adults: Diagnosis and Management. Am Fam Physician. 2016;94(9):698–706.
  24. Gautret P Lagier J-C Parola P Hoang VT Meddeb L Mailhe M Hydrochloroquine and Azithromycin as a Treatment of COVID-19: Results of an Open-Label Non-Randomized Clinical Trial. Int J Antimicrob Agents. 2020;105949. doi:.https://doi.org/10.1016/j.ijantimicag.2020.105949
  25. Pandya PH Murray ME Pollok KE Renbarger JL. The Immune System in Cancer Pathogenesis: Potential Therapeutic Approaches. J Immunol Res. 2016;2016:4273943. doi:.https://doi.org/10.1155/2016/4273943
  26. Joffroy CM Buck MB Stope MB Popp SL Pfizenmaier K Knabbe C. Antiestrogens induce transforming growth factor beta-mediated immunosuppression in breast cancer. Cancer Res. 2010;70(4):1314–22. doi:.https://doi.org/10.1158/0008-5472.CAN-09-3292
  27. Schaer DA Beckmann RP Dempsey JA Huber L Forest A Amaladas N The CDK4/6 Inhibitor Abemaciclib Induces a T Cell Inflamed Tumor Microenvironment and Enhances the Efficacy of PD-L1 Checkpoint Blockade. Cell Rep. 2018;22(11):2978–94. doi:.https://doi.org/10.1016/j.celrep.2018.02.053
  28. Xiao BG Lu CZ Link H. Cell biology and clinical promise of G-CSF: immunomodulation and neuroprotection. J Cell Mol Med. 2007;11(6):1272–90. doi:.https://doi.org/10.1111/j.1582-4934.2007.00101.x
  29. Cardoso PRG Matias KA Dantas AT Marques CDL Pereira MC Duarte ALBP Losartan, but not Enalapril and Valsartan, Inhibits the Expression of IFN-γ, IL-6, IL-17F and IL-22 in PBMCs from Rheumatoid Arthritis Patients. Open Rheumatol J. 2018;12(1):160–70. doi:.https://doi.org/10.2174/1874312901812010160
  30. Nemati F Rahbar-Roshandel N Hosseini F Mahmoudian M Shafiei M. Anti-inflammatory effects of anti-hypertensive agents: influence on interleukin-1β secretion by peripheral blood polymorphonuclear leukocytes from patients with essential hypertension. Clin Exp Hypertens. 2011;33(2):66–76. doi:.https://doi.org/10.3109/10641963.2010.496521
  31. Zhu L Xu X Ma K Yang J Guan H Chen S Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant. 2020;ajt.15869. doi:.https://doi.org/10.1111/ajt.15869
  32. Ritchie AI Singanayagam A. Immunosuppression for hyperinflammation in COVID-19: a double-edged sword? Lancet. 2020;395(10230):1111. doi:.https://doi.org/10.1016/S0140-6736(20)30691-7
  33. Wyska E. Pretreatment with R(+)-verapamil significantly reduces mortality and cytokine expression in murine model of septic shock. Int Immunopharmacol. 2009;9(4):478–90. doi:.https://doi.org/10.1016/j.intimp.2009.01.013
  34. Seelig A. A general pattern for substrate recognition by P-glycoprotein. Eur J Biochem. 1998;251(1-2):252–61. doi:.https://doi.org/10.1046/j.1432-1327.1998.2510252.x