<div>Title: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
infection after allogeneic stem cell transplantation.</div><div>Takashi Onaka<sup>1)</sup>,M.D.,Fumie Iwai<sup>1)</sup>,
Ph.D.,M.D.,Aiko Kato-Ogura<sup>1)</sup>, Ph.D.,M.D. Akihito
Yonezawa<sup>1)</sup>, Ph.D.,M.D.</div><div>1)Department of Hematology, Kokura Memorial Hospital,Japan</div><div>Corresponding author: Takashi Onaka,M.D.</div><div>3-2-1,Asano,Kokura-kita,Kitakyushu,Fukuoka,Japan</div><div>Tel +81-93-511-2000Fax +81-93-511-2259</div><div>e-mail:<i>takashionaka3@gmail.com</i></div><div>Key Clinical Massege: This is the first report of a case of COVID-19
after allogeneic stem cell transplantation. Our case suggests that
COVID-19 may exist without characteristic CT images, especially in
immunocompromised hosts, such as patients after transplantation.</div><div>Key words:COVID-19,Allogeneic transplantation,malignant lymphoma</div><div>Introduction:</div><div>Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the
novel coronavirus first detected in Wuhan, China.The virus causes
coronavirus disease 2019 (COVID-19).Over 1000000 cases of COVID-19 have
been confirmed worldwide.<sup>1</sup>Here, we report the first
case of COVID-19 after allogeneic stem cell transplantation.</div><div>Case Examination:</div><div>A 61-year-old male with diffuse large B cell lymphoma transformed from
follicular lymphoma underwent peripheral blood stem cell transplantation
(PBSCT) from his HLA haploidentical daughter. He underwent de-escalation
of immunosuppressant drugs because of early relapse after PBSCT. The
duration of chronic graft-versus-host disease(GVHD) was extended, but he
did not need additional therapy. At day 205 after PBSCT, he had a fever
of 100°F and a wet cough. He visited our hospital because his symptoms
persisted for two days. He had not traveled to a foreign country nor had
contact with anyone with COVID-19. His chest X-ray showed no apparent
bacterial pneumonia, and a CT scan showed only small nodules that were
diagnosed as scar tissue from past organizing pneumonia and pleural
effusion (figure 1). Although he was radiographically atypical for
COVID-19,a COVID-19 PCR test was performed on a nasopharyngeal swab.
Laboratory tests showed leukopenia (WBC 1000/μl),neutropenia (ANC 20/μl)
, a high procalcitonin level (8.94 ng/ml), and a high CRP level (26.3
mg/dl). He was hospitalized and started taking antibiotics with a
diagnosis of community-acquired pneumonia.PCR was positive the day after
hospitalization.By the ninth day in the hospital, his respiratory
condition had not worsened.</div><div>Discussion:</div><div>Currently, COVID-19 is spreading around the world. It has been reported
that there are typical COVID-19 imaging patterns on chest CT. Chinese
researchers revealed bilateral lung opacities on chest CT in COVID-19
patients and described lobular and subsegmental areas of consolidation
as the most typical findings.<sup>2</sup> Another study found
that the hallmarks of COVID-19 on imaging were bilateral and peripheral
ground-glass and consolidative pulmonary
opacities.<sup>3</sup>However, in our patient, we did not find
typical findings on CT. This is the first report of a case of COVID-19
after allogeneic stem cell transplantation. Absence of the
characteristic imaging features might be related to leukopenia or
immunosuppression. Our case suggests that COVID-19 may exist without
characteristic CT images, especially in immunocompromised hosts, such as
patients after transplantation.</div><div>Conclusion:</div><div>Although there are many unclear points about COVID19, there may not have
shown typical images, and it is important to note the possibility of
infection, especially in immunocompromised patients.</div><div>Authorship</div><div>TO: managed the patient and wrote the manuscript.</div><div>FI,AO,and AY: reviewed the manuscript.</div><div>Conflict of interest</div><div>None declared.</div><div>Figure legend</div><div>1-A) Chest CT findings. Organizing pneumonia was observed in both upper
lobes.</div><div>1-B) Chest CT findings.Bilateral pleural effusion was present.</div><div>References</div><div>1. World Health Organization. Novel coronavirus — China. January12,
2020
(http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/.
opens in new tab).</div><div>2.Huang C, Wang Y, Li X et al.Clinical features of patients infected
with 2019 novel coronavirus in Wuhan, China. Lancet<b>2</b> 020 January
24 (Epub ahead of print), doi: 10.1016/S0140-6736(20)30183-5.</div>