Atypical pneumonia vs. COVID-19 in treating Hodgkin's Lymphoma

Abstract

Introduction: In times of COVID-19 pandemic, all respiratory symptoms or febrile syndrome leads to ruling out said infection, but atypical Pneumocystis Jirovecii pneumonia (PCP) must be taken into account, especially in onco-hematological patients, as differential diagnosis.Objective: To describe the case of atypical pneumonia vs. COVID-19 in a patient with Hodgkin's lymphoma.Clinical case report: The case of a 30-year-old female patient with diagnosis of clinical stage III Hodgkin lymphoma (IBD) is reported. She began systemic treatment with R-ABVD chemotherapy scheme (6-course plan with parts A and B). She received 3 R-ABVD courses with complete response according to tomography. When scheduling 4th course, part B, she had feverish persistence up to 39.8 ° C associated with nocturnal diaphoresis, worsening in the last week, so hospitalization was decided. A contrast tomography (TEM c / c) of the thorax was performed: ground-glass opacities interspersed with fibrous lesions in both lungs, no adenopathy; lactic dehydrogenase (DHL): 656 IU / L. No respiratory symptoms, or altered respiratory physical examination, to rule out PCP vs. COVID-19 pneumonia. No leukocytosis, negative COVID-19 polymerase chain reaction (PCR). It is defined as non-coronavirus associated pneumonia, so she received 2 days of Sulfamethoxazole + Trimethoprim antibiotics. On the clinical course, she exhibited improvement of general malaise and she was afebrile. She completed 6 courses of R-ABVD, with complete response in tomographic re-evaluation, she was asymptomatic and had non-reactive rapid test for COVID-19.Conclusions: In the context of COVID-19 pandemic, the differential diagnosis must be timely.Keywords: Hodgkin lymphoma; COVID-19; Pneumocystis Jirovecii pneumonia.