Self-limiting severe neutropenia in a patient with COVID-19

Abstract

Neutropenia is a rare haematological complication of COVID-19 infection in immunocompetent patients. There is sparse literature on neutropenia in patients with COVID-19, except a few case reports. We encountered a similar case in an intensive care unit that developed severe neutropenia on day 24 of illness. Neutropenia resolved spontaneously on 4th day of its appearance. The patient was isolated and kept under close observation, antibiotics were upgraded and strict asepsis was maintained. Thus, we observed in a patient with no comorbidities and uncomplicated neutropenia that strict measures to prevent infection may suffice and the undue risk of hematopoietic therapy can be avoided. An expert opinion should always be sought in such cases as the presence of complications may require an aggressive approach.

Entecavir‐induced neutropenia in an adult living donor liver transplant recipient: Successful conversion to tenofovir alafenamide

“…Severe COVID‐19 is a result of inappropriate and deleterious cytokine storm culminating in multiorgan failure even in healthy individuals. Lymphopenia is predominant but neutropenia has also been reported, 15,16 hence confounding this patient's existing neutropenia.…”

Ultra-rare RTEL1 gene variants associate with acute severity of COVID-19 and evolution to pulmonary fibrosis as a specific long COVID disorder

“…describe an early reversible neutropenia after cyclophosphamide treatment in pulmonary fibrosis patients with RTEL1 variants [ 10 ]. Among hematological abnormalities, the incidence of lymphopenia ranged from 40 to 80%, with increased NLR [ 35 ] associated with higher mortality rates, especially for severe cases of COVID-19 [ 36 , 37 ]. We hypothesize that NLR alterations stem from the invasiveness of ventilation procedures.…”

Clinical practice guideline for clozapine use in patients with COVID‐19

“…COVID‐19 infection (as with other viral infections) can cause neutropenia, most likely transient and self‐limiting 23,24,25 and has been seen in patients on clozapine with COVID‐19 infection 26,27 . This poses a challenge for clinicians about whether to continue or stop clozapine, and if stopped, whether a clozapine rechallenge is possible, as well as the risks associated with cessation.…”

“…20,21,22 Overlap of COVID-19 and clozapine adverse effects COVID-19 infection can cause symptoms that overlap with that of clozapine adverse effects, including fever, fatigue, 'flu-like symptoms', cough and shortness of breath (symptoms potentially related to either COVID-19 or clozapine-induced neutropenic sepsis/myocarditis). 3 COVID-19 infection (as with other viral infections) can cause neutropenia, most likely transient and self-limiting 23,24,25 and has been seen in patients on clozapine with COVID-19 infection. 26,27 This poses a challenge for clinicians about whether to continue or stop clozapine, and if stopped, whether a clozapine rechallenge is possible, as well as the risks associated with cessation.…”