Development of COVID Respiratory Failure in a Patient with B-cell Lymphoma: A Case Report

Background: Few studies examine the care for patients with hematological malignancy complicated by COVID-19 and sequelae of treatment. Case description: A 60 yo Caucasian male presented to the ED with chest discomfort and dyspnea. He had a history of HTN, HFrEF, T2DM, Stage 3 CKD, and morbid obesity. CXR revealed a large mediastinal mass, prompting biopsy. One week later, he returned to the ED with worsening dyspnea, chest pain and edema. CXR revealed a right pleural effusion and ECG showed AFib. He was diagnosed with acute-on-chronic respiratory failure with hypoxia; O2 nasal cannula, a thoracentesis, and antibiotics were started. The hospital course was complicated by multifactorial decompensation, tracheostomy placement, ICU admission for hospital-acquired pneumonia, septic shock, ATN, and AFib with RVR. Medical stabilization was achieved with combination therapy including antibiotics, supplemental O2, anti-arrhythmics, and antiplatelets. Mediastinal mass biopsy demonstrated low grade B-cell non-Hodgkin's lymphoma and cyclophosphamide, vincristine, with prednisone were initiated. However, severe hyperglycemia ensued requiring an insulin drip and chemotherapy discontinuation. He later developed persistent diarrhea and tested positive for recurrent C.difficile; vancomycin was started. On day 34, he was again transferred to the ICU for respiratory distress and tested positive for COVID-19. High flow O2, convalescent plasma, decadron and remdesivir were started. Eventually, the patient reached medical clearance on day 61 and was discharged with home health for rehabilitation and care. Conclusions: This case report presents the complex management required for patients with lymphoma and COVID-19.