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22 September 2022 : Case report  USA

[In Press] Rare Case of Persistently Depressed T Lymphocyte Subsets After SARS-CoV-2 Infection

Unusual clinical course

Pamela L. Alebna1ABCDE, Shannay Bellamy1BC, Terrence A. Tabur1D, Anthony Mangia2A

DOI: 10.12659/AJCR.937760

Am J Case Rep In Press; DOI: 10.12659/AJCR.937760  

Available online: 2022-09-22, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
On rare occasions, viral infections are known to also depress immune cell lines, further worsening clinical outcomes. We describe a patient who presented 3 weeks after recovery from mild COVID-19 disease with clinical features of an atypical pneumonia and was found to have a low CD4+ T-cell count.
CASE REPORT
An 82-year-old man with a past medical history of coronary artery disease, rheumatoid arthritis, gout, hypertension, and atrial fibrillation presented with a 1-week history of progressively worsening shortness of breath and cough. He was noted to have recovered from mild SARS-CoV-2 infection 3 weeks prior to his current presentation and had been at his baseline level of health following infection. A T cell subset panel was obtained, which revealed an absolute CD3 count of 92 (reference range 840-3060), absolute CD4 count of 52 (reference range 500-1400), absolute CD8 count of 37 (reference range 180-1170), and a normal CD4: CD8 ratio. He was subsequently started on atovaquone for pneumocystis jiroveci pneumonia prophylaxis.
CONCLUSIONS
This case highlights the need for a high index of suspicion for lymphocyte depletion in older patients with multiple comorbidities who present during or after SARS-CoV-2 infection with atypical symptoms that are suggestive of immunosuppression. In such instances, there should be a low threshold to start prophylactic therapy for possible opportunistic infections.

Keywords: Lymphopenia; COVID-19; Immunosuppression

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Rare Case of Persistently Depressed T Lymphocyte Subsets After SARS-CoV-2 Infection

Am J Case Rep In Press; DOI: 10.12659/AJCR.937760  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923