Presentation
History of diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor (CAR) T-cell therapy, in remission for 2 years. Presenting with new-onset cough, headaches and fever.
Patient Data
There are nodular opacities in the right upper lobe.
New ground-glass opacities noted within the left upper and lower lobes as well as the right upper and middle lobes. Small areas of ground-glass noted at the dependent portion of the right lower lobe. The central airways are patent. Mild bronchial wall thickening present.
New consolidation and ground-glass opacities in the right upper and middle lobes as well as a new small area of ground-glass opacities in the left upper lobe. New partial collapse of the right middle lobe. Some interval improvement in left lower lobe dependent airspace disease.
Patient was persistently COVID-19 seropositive (as measured by RT-PCR on a weekly basis) for the entirety of the disease course.
Histological findings from a trans-bronchial biopsy performed 6 weeks from the first COVID-19 seropositive test revealed areas of hyaline membrane formation and organizing phases suggestive of diffuse alveolar damage.
Case Discussion
In the setting of waxing and waning ground-glass opacities, persistently seropositive COVID-19, and negative bacterial or fungal infectious work-up, prolonged COVID-19 infection should be suspected.
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