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• W4387254205 abstract "SESSION TITLE: Chest Infections Case Report Posters 26 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Persistent COVID-19 RT-PCR positivity is reported in patients with hematological malignancies and immunosuppression up to 70 days after infection. We explore the implications of the test through the case of an elderly male with diffuse large B-cell lymphoma (DLBCL) with a positive test 90 days after infection. CASE PRESENTATION: A 72-year-old male with a past medical history of diabetes, chronic kidney disease (stage 3b), Stage 3 DLBCL (diagnosed 5 months prior) presented with generalized weakness and diarrhea. He had received his fifth cycle of R-CHOP and G-CSF 9 days prior. History was notable for COVID-19 antigen positivity 90 days prior that manifested as sinusitis and was managed conservatively. He had received 2 doses of COVID-19 mRNA vaccine. Physical examination showed tachycardia 110 bpm, tachypnea 20 breaths/min, blood pressure 104/68, hypothermia and cachexia. Laboratory tests revealed WBC 0.50/microL, neutrophils 24%, Hb 8.5 gm/dL, platelets 55k/microL, lactate 4 mmol/L, glucose 72 mg/dL, sodium 127 mmol/L and acute on chronic kidney injury. He tested positive for COVID-19 by PCR with negative antigen testing. He was treated for gram negative bacteremia secondary to proctitis and rectal perforation despite which his condition deteriorated. He was transitioned to comfort care per family wishes. DISCUSSION: The SARS-COV2 RT-PCR test usually returns negative 28 days after infection. Persistent test positivity upto 74 days after the original infection has been seen in patients with hematological malignancies (1). This phenomenon has been associated with increased mortality (2). CDC recommends positive tests after 90 days to be treated as reinfection. It is however unlikely that our patient had a reinfection given the absence of typical symptoms because of which he was not treated for active COVID infection. While asymptomatic reinfection with COVID is a possibility, the patient was notably non-infectious despite being in close contact with family. It is therefore more likely that his active lymphoma and chemotherapy crippled his ability to produce antibodies to surmount his original infection resulting in prolonged viral shedding (3). The use of CD20 inhibitors in B-cell lymphoma has also been associated with lower rates of seroconversion following vaccination with the mRNA vaccines. Despite the viral shedding it is also questionable as to whether these patients are actively transmitting the infection in view of which the need for isolation precautions remains debatable. CONCLUSIONS: A persistent COVID positive test in lymphoma patients must be analyzed carefully while determining treatment and isolation needs. It is especially important to make these distinctions since active COVID infection in lymphoma can have mortality rates as high as 40%. REFERENCE #1: Karataş A, İnkaya AÇ, Demiroğlu H, et al. Prolonged viral shedding in a lymphoma patient with COVID-19 infection receiving convalescent plasma. Transfus Apher Sci. 2020;59(5):102871. doi:10.1016/j.transci.2020.102871 REFERENCE #2: Martínez-Chinchilla C, Vazquez-Montero L, Palazón-Carrión N, et al. Persistence of SARS-CoV-2 Infection in Severely Immunocompromised Patients With Complete Remission B-Cell Lymphoma and Anti-CD20 Monoclonal Antibody Therapy: A Case Report of Two Cases. Front Immunol. 2022;13. doi:10.3389/fimmu.2022.860891 REFERENCE #3: Lee CY, Shah MK, Hoyos D, et al. Prolonged SARS-CoV-2 infection in patients with lymphoid malignancies. Cancer Discov. 2022;12(1):62-73. doi:10.1158/2159-8290.CD-21-1033 DISCLOSURES: No relevant relationships by Lavleen Kaur No relevant relationships by Aishwarya Krishnaiah No relevant relationships by Sarasija Natarajan No relevant relationships by Pius Ochieng No relevant relationships by Yamini Patel No relevant relationships by Lekha Yadukumar" @default.
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• W4387254205 date "2023-10-01" @default.
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• W4387254205 title "SIGNIFICANCE OF PERSISTENT COVID-19 PCR POSITIVITY IN LYMPHOMA PATIENTS" @default.
• W4387254205 doi "https://doi.org/10.1016/j.chest.2023.07.925" @default.
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