Images of Infectious Diseases
42M on obinutuzumab for CLL. 4 mo ago: mild COVID-19 - no specific Rx. 3 mo ago: SARS-CoV-2 mRNA vaccine.
CC: 2 mo on/off fever, cough, dyspnea. NP SARS-CoV-2 PCR neg. Rx as CAP w doxycycline - no response.
CT chest. DDx? Work up? #MayoIDQ next
42M on obinutuzumab for CLL. 4 mo ago: mild COVID-19 - no specific Rx. 3 mo ago: SARS-CoV-2 mRNA vaccine.
CC: 2 mo on/off fever, cough, dyspnea. NP SARS-CoV-2 PCR neg. Rx as CAP w doxycycline - no response.
CT chest. DDx? Work up? #MayoIDQ next
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Four months after mild COVID-19, an ICH man with CLL on obinutuzumab presents with prolonged / recurrent doxycycline-non responsive CAP. CT chest shown. See prior tweet for other details. Which of the following is the most likely diagnosis? #MayoIDQ
Four months after mild COVID-19, an ICH man with CLL on obinutuzumab presents with prolonged / recurrent doxycycline-non responsive CAP. CT chest shown. See prior tweet for other details. Which of the following is the most likely diagnosis? #MayoIDQ
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All of the MCQ choices could be possible in this case. Imaging suggested viral or PJP.
Work up:
Serum BDG / GM negative
CMV PCR negative
BAL PJP PCR negative
BAL SARS-CoV-2 PCR +++
SARS-CoV-2 spike/nucleocapsid Ab negative (despite infection / vaccine)
All of the MCQ choices could be possible in this case. Imaging suggested viral or PJP.
Work up:
Serum BDG / GM negative
CMV PCR negative
BAL PJP PCR negative
BAL SARS-CoV-2 PCR +++
SARS-CoV-2 spike/nucleocapsid Ab negative (despite infection / vaccine)
4/
Case diagnosis: Persistent COVID-19 pneumonia in B-cell depleted host with CLL Rx with anti-CD20 obinutuzumab
The patient was Rx with IV Remdesivir and high-titer convalescent plasma EUA
Case diagnosis: Persistent COVID-19 pneumonia in B-cell depleted host with CLL Rx with anti-CD20 obinutuzumab
The patient was Rx with IV Remdesivir and high-titer convalescent plasma EUA
6/
Anti-CD20 Rx and infection prophylaxis
Obinutuzumab is a monoclonal antibody that targets CD20, which is found on the surface of B cells
Prophylaxis vs. PJP and herpes viruses (HSV / VZV) if anti-CD20 is combined with high dose steroids
Anti-CD20 Rx and infection prophylaxis
Obinutuzumab is a monoclonal antibody that targets CD20, which is found on the surface of B cells
Prophylaxis vs. PJP and herpes viruses (HSV / VZV) if anti-CD20 is combined with high dose steroids
11/
Clinical Pearl
ICH patients treated with anti-CD20 may have suboptimal immune response to covid-19 —> leading to persistent infection
Clinical Pearl
ICH patients treated with anti-CD20 may have suboptimal immune response to covid-19 —> leading to persistent infection
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Clinical Pearl
ICH patients treated with anti-CD20 may have suboptimal immune response to SARS-CoV-2 vaccine—> may remain at risk of infection (post-vaccine infections have been observed).
Thanks for participating!
Clinical Pearl
ICH patients treated with anti-CD20 may have suboptimal immune response to SARS-CoV-2 vaccine—> may remain at risk of infection (post-vaccine infections have been observed).
Thanks for participating!
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