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COVID-19 in a Hairy Cell Leukemia Patient: A Rare Case Report
Hirohito Sano1, Koji Murakami1, Hisayuki Yokoyama2
1Department of Respiratory Medicine, Tohoku University Graduate School of Medicine.
Insights
This case report details a patient with hairy cell leukemia (HCL) diagnosed after COVID-19 infection, presenting with persistent pancytopenia. It highlights the importance of considering hematologic malignancies in patients with prolonged cytopenia post-COVID-19.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Hairy cell leukemia (HCL) is a rare B-cell chronic lymphoid leukemia.
- The clinical presentation of coronavirus disease 2019 (COVID-19) in HCL patients is not well-documented.
- Persistent pancytopenia after COVID-19 infection warrants investigation for underlying hematologic conditions.
Observation:
- A 56-year-old man diagnosed with COVID-19 presented with ground-glass opacities and splenomegaly.
- Despite treatment with remdesivir and dexamethasone, the patient experienced prolonged pancytopenia.
- Bone marrow examination confirmed a diagnosis of HCL, making this the first reported case in Japan.
Findings:
- This case represents the first instance of HCL diagnosed following COVID-19 in Japan, characterized by persistent pancytopenia.
- Unlike previously reported HCL patients with COVID-19, this patient's illness was not severe, requiring no mechanical ventilation.
- Lower interleukin-6 (IL-6) levels in this patient compared to prior cases suggest potential racial differences in IL-6 production influencing COVID-19 severity.
Implications:
- Clinicians should maintain a high index of suspicion for hematologic malignancies, such as HCL, in patients with persistent pancytopenia or splenomegaly after COVID-19.
- This case expands the understanding of HCL and COVID-19 co-occurrence, noting a less severe presentation.
- Further research into racial variations in cytokine production, like IL-6, may elucidate differential COVID-19 severity in HCL patients.
Abstract:
The detailed clinical course of coronavirus disease 2019 (COVID-19) in patients with hairy cell leukemia (HCL) is rarely reported. We report the first case of HCL diagnosed with prolonged pancytopenia after COVID-19 infection in Japan. We describe the case of a 56-year-old man who was diagnosed with COVID-19. Computed tomography revealed ground-glass opacities in the bilateral lung lobes as well as splenomegaly. Remdesivir and dexamethasone were administered for the treatment of COVID-19. Since the pancytopenia persisted, bone marrow examination was performed, and he was diagnosed with HCL. Although pancytopenia can occur with COVID-19 alone, clinicians should be alerted regarding the presence of hematologic malignancies in patients in whom pancytopenia persists after COVID-19 treatment or in those with splenomegaly. Further, the condition of all previously reported patients with COVID-19 associated with HCL was severe enough to require mechanical ventilation. This is the first case in which the disease was not severe. The interleukin-6 (IL-6) level was lower in this case than in previous cases, suggesting that racial differences in IL-6 production may have contributed to COVID-19 severity.
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