SHM Converge Scientific Abstract ePoster Gallery-Covid-19 Ards in a Covid-19 Vaccinated Individual in the Setting of Newly Diagnosed Non-Hodgkin's B-Cell Lymphoma

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This case report describes an 81-year-old man with multiple chronic illnesses who was fully vaccinated with the Moderna COVID-19 vaccine but still developed severe COVID-19 pneumonia and acute respiratory distress syndrome (ARDS). During hospitalization for worsening shortness of breath, he was found to have persistent lymphocytosis and later diagnosed with newly identified non-Hodgkin B-cell lymphoma based on flow cytometry, with FISH analysis also performed.<br /><br />Because his SARS-CoV-2 PCR had a low cycle threshold, suggesting high viral load, the authors believe his poor vaccine response was likely related to the underlying lymphoma, which can impair immune function. He did not develop a protective antibody response. Despite treatment with dexamethasone, tocilizumab, remdesivir, broad-spectrum antibiotics, and later high-dose steroids for worsening ARDS, his respiratory status deteriorated. A probable pulmonary embolism was also suspected and treated with Lovenox. He required substantial oxygen support, including Optiflow and AVAPS, but ultimately died.<br /><br />The discussion emphasizes that COVID-19 vaccine immunogenicity is often reduced in immunocompromised patients, especially those with hematologic malignancies. It notes that ongoing studies are evaluating antibody and T-cell responses to vaccination in lymphoma and other cancer patients, but it remains difficult to separate the effects of the cancer itself from effects of cancer treatment. The authors suggest that some patients with indolent lymphomas may need additional protection, such as booster doses or prophylactic monoclonal antibodies. They also stress the importance of continued masking and other transmission-reduction measures to protect vulnerable cancer patients, even in the vaccinated era.

Asset Subtitle

Shilpa Peddi

Meta Tag

Author List Shilpa Peddi

Category Clinical Vignettes

Concept COVID-19 Vaccine Immunogenicity

Concept Acute Respiratory Distress Syndrome

Concept Hematologic Malignancy

Concept B-Cell Lymphoma

Concept Breakthrough Infection

Distinguished Non-Finalist

Presenter Organization St. Luke's

Presenting Author Shilpa Peddi

Track Adult

Keywords

COVID-19 pneumonia

acute respiratory distress syndrome

Moderna vaccine

non-Hodgkin B-cell lymphoma

immunocompromised

vaccine immunogenicity

lymphocytosis

flow cytometry

tocilizumab

remdesivir

COVID-19 Vaccine Immunogenicity

Acute Respiratory Distress Syndrome

Hematologic Malignancy

B-Cell Lymphoma

Breakthrough Infection