PMC7348056_01
The clinical characteristics and treatment of a COVID-19 patient with chronic lymphocytic leukemia (CLL) (I-2) from a familial cluster during 69 days of follow-up. (A) Genealogical tree of patient I-2. (B) Chest CT of patient I-2 on day -7 (a1,a2), day 1 (b1,b2,b3), day 8 (c1,c2), day 18 (d1,d2), day 26 (e1,e2), day 35 (f1,f2), and day 47 (g1,g2). (C) Peripheral blood smear of patient I-2 (Wright's staining, oil-immersion lens, 1,000 x). (D) Immunophenotyping of peripheral blood cells of patient I-2. (E) Time at home or in hospital, clinical symptoms, positive or negative novel coronavirus nucleic acid result, and the use of antiviral drugs and immune modulators for 69 days of follow-up of patients I-2, I-1, and II-3. a-2b: interferon alpha-2b, IVIG: intravenous immunoglobulin.
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Figure 1A shows the genealogical family tree. A chest computed tomography scan (CT) (Figure 1Ba1,a2) revealed slight bronchopneumonia in the superior lobe of the right lung. A (0.75 U/L; range,0.82-4.53). A blood smear showed a large number of mature lymphocytes (Figure 1C). Immunophenotypic analysis showed that a single B lymphocyte clone accounted for 73.3% in non-erythroid cells; these cells were CD19dim, CD5+, CD22+, CD20+, CD23+, CD200+, and FMC7+, while kappa light chain was restrictively expressed, and CD10, CD103, and sIgM were not expressed (Figure 1D). Multiple areas of ground-glass opacities under the pleura of both lungs were observed on chest CT on the admission day (Figure 1Bb1-b3). Figure 1E shows the symptoms, the results of the virus RT-PCR tests, and the treatments used for I-2, I-1, and II-3 during a follow-up period of 69 days. Chest CT revealed focal consolidation accompanied by fibrosis in the patient on day 8 (Figure 1Bc1,c2). Re-examination with chest CT on day 18 revealed the absorption of pneumonia (Figure 1Bd1,d2). Chest CT revealed obvious improvement of the double lung infection in the patient on day 26 (Figure 1Be1,e2). Chest CT revealed new ground-glass shadows in the patient (Figure 1Bf1,f2). Chest CT showed obvious absorption of the infection in the patient on day 47 (Figure 1Bg1,g2).
Comparison of laboratory results of patients from a household cluster with COVID-19 during 69 days of follow-up. (A) Trends of the neutrophil-to-lymphocyte ratio (NLR) during follow-up for 69 days. (B) Ct values for detection of novel coronavirus nucleic acid. (C) IgG, IgM, and IgA levels of I-2, I-1, and II-3 at initial diagnosis. Changes in (D) routine blood examination values, (E) C-reactive protein (CRP), (F) D-dimers, (G) liver function including galanine transaminase and total bilirubin, (H) renal function including creatinine and blood urea nitrogen in patients I-2, I-1, and II-3 during the 69-day follow-up. *p = 0.01-0.05 and ***p < 0.001.
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Multiple areas of ground-glass opacities under the pleura of both lungs were observed on chest CT on the admission day (Figure 1Bb1-b3). Compared with that of I-1 and II-3, the neutrophil-to-lymphocyte ratio (NLR) of I-2 was significantly lower (P < 0.05) (Figure 2A, t-test, using SPSS software version 22). According to the Ct values determined with the SARS-Cov-2 virus test, I-2 had the lowest Ct value among the three patients regardless of whether the specimen was from the initial nasopharyngeal swab or initial sputum (Figure 2B). At diagnosis, the levels of immunoglobulin (Ig) G, IgA, and IgM for I-2 were among the lowest of those of the family members (Figure 2C). The white blood cell (WBC) and lymphocyte counts for I-2 were evidently high, and they dropped significantly after every recurrent novel coronavirus infection (Figure 2D). The expressions of CRP and D-dimer were significantly elevated during the process of treatment (Figures 2E,F). However, no remarkable changes were observed in hepatorenal function in I-1, II-3, and I-2 (Figures 2G,H).
Dynamic trends in the lymphocyte subsets and cytokines in peripheral blood among patients within a household cluster with COVID-19 during 69 days of follow-up. Trends of (A) lymphocyte subsets; (B) B lymphocytes; (C) CD8+ T lymphocytes; (D) CD4+ T lymphocytes. (E) Level of IL-6 in peripheral blood as detected by flow cytometry; (F) level of Il-10 in peripheral blood as detected by flow cytometry.
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Multiple areas of ground-glass opacities under the pleura of both lungs were observed on chest CT on the admission day (Figure 1Bb1-b3). The dynamic trends of CD4+ and CD8+ lymphocytes, B lymphocytes, and cytokines IL-6 and IL-10 in patients I-2, I-1, and II-3 within 69 days of follow-up are shown in Figure 3. At first, the numbers of CD4+ and CD8+ lymphocytes of I-2 were higher than those of II-3 and I-1, while the CD4+/CD8+ ratio of I-2 was lower than that of the other two subjects (Figures 3C,D). Significant increases in IL-6 levels were observed in I-2 before the first recurrence (Figure 3E), and the IL-10 levels in I-2 were high before the second recurrence (Figure 3F).