Recurrent Cytokine Storm in SARS-CoV-2 Infected Patients with Hematolymphoid Malignancy: A New Perspective

Sujeet Kamtalwar

Cancer patients, especially with hematological malignancies are at higher risk of contracting coronavirus disease 2019 (COVID-19) because of the immunosuppressed state both due to the malignancy and medications administered as a part of cancer management. Cytokine storm or acute respiratory distress syndrome (ARDS) is the major cause of deaths due to COVID-19. However, delayed cytokine storm can be seen until 21 days of illness. Herein, we report two patients of hematolymphoid malignancy with COVID-19 who had recurrent cytokine storm which is uncommon.

India alone has witnessed over 41 million cases of COVID-19 with approximately 1.19% mortality.[1] Though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be asymptomatic or present with mild symptoms in majority, patients can progress to ARDS. Seventeen studies from 2,486 hospitals over 5 countries performed from the beginning of the pandemic to July 2020 reported a variable incidence of ARDS in SARS-CoV-2 infection ranging from 2 to 68%.[2] Most cases with COVID-19 and ARDS were either elderly or having comorbidities.[3] According to a meta-analysis[4] performed in 2020, cancer patients with COVID-19 infection were associated with a 28% day-28 mortality, much higher as compared with noncancer patients. We reported from our institute that cancer patients have 10 times higher mortality as compared with noncancer patients (10% vs. 1.1%).[5] However, repeated episodes of ARDS in the same patient have not been described in literature. We present here two case scenarios of patients with B cell non-Hodgkin lymphoma (B-NHL) who presented with two discrete episodes of severe COVID-19 with cytokine storm with an interim asymptomatic period.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

The manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and that each author believes that the manuscript represents honest work.

Publication History

Article published online:
11 August 2023

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