Multiple durgs

Abstract

Multiple durgs COVID-19 infection and off label use: case reportA 59-year-old man developed a covid-19 infection during treatment with bendamustine, bleomycin, cyclophosphamide, dacarbazine, doxorubicin, etoposide, obinutuzumab, prednisone, procarbazine, vinblastine and vincristine for classical Hodgkin lymphoma. Additionally, he received off label treatment with azithromycin, hydroxychloroquine, lopinavir/ritonavir and convalescent-anti-SARS-CoV-2-plasma for covid-19 infection [routes and dosages not stated].The man diagnosed with classical Hodgkin lymphoma, and started receiving treatment with doxorubicin [adriamycin], bleomycin, vinblastine and dacarbazine. Due to the incomplete response and residual disease, he was further treated with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone along with involved-site radiation therapy. Subsequently, he developed follicular lymphoma (grade IIIA), and he started receiving bendamustine and obinutuzumab [G-Benda] due to enlarging lymphadenopathy. In the meantime, he was brought to the emergency department due to shortness of breath and dry cough for 1 week. In the hospital, he underwent various laboratory investigations. A nasopharyngeal swab test, was found to be positive for SARS-CoV-2 infection. COVID-19 was determined to be related to chemotherapy.The man started receiving off label treatment with hydroxychloroquine, azithromycin and lopinavir/ritonavir due to his increasing oxygen requirement. Additionally, he received one unit of convalescent-anti-SARS-CoV-2-plasma [convalescent plasma; off-label treatment] due to insignificant improvement. He received a second unit of convalescent-anti-SARS-CoV-2-plasma due to minimal efficacy. Subsequently, he received an immune globulin [immunoglobulin]. However, his respiratory status worsened, and remdesivir was started. Further, his respiratory status improved long with decrease in oxygen requirement. After 90 days of hospitalisation, he was discharged, but his COVID-19 PCR testing was found to be positive during discharge. After 20 weeks of initial diagnosis, COVID-19 PCR test was negative. His chemotherapy was discontinued due to poor response. After 2 months of discharge, he re-visited the hospital due to chills, worsening shortness of breath, and a productive cough, and he was hospitalised. At the time of hospitalisation, he was febrile, tachycardic, hypotensive, and hypoxic, which required oxygen. A repeated COVID-19 test revealed a negative result. After that, he underwent a chest X-ray, which showed a right lower lobe consolidation and a CT scan revealed slight improvement in ground glass opacities, no pulmonary embolism and increased right lung consolidation. Hence, bacterial pneumonia was presumed and unspecified antibiotics and immune globulin were started. His fever persisted. Hence, a bronchoscopy was performed, which showed normal flora and was negative for bacterial, fungal and viral infections. Repeat nasopharyngeal tests were performed, which came negative. Despite...