SARS-CoV-2 recurrent infections in a patient with metastatic colon cancer during chemotherapy

Abstract

A 72-year-old man with a metastatic KRAS gene mutated colon adenocarcinoma was admitted to the hospital for effort dyspnea and subfebrile body temperature. He was after transversostomy in 2019 and in the course of a palliative chemotherapy FOLFIRI regimen (irinotecan, calcium folinate, 5-fluorouracil) with secondary prophylaxis with filgrastim. On admission (August 2020), his general condition was quite good — Eastern Cooperative Oncology Group Performance Scale 1 (ECOG PS 1). He reported fatigue, dyspnea, partial loss of taste, and cold sweat. A polymerase chain reaction test (RT-PCR; KIT LabSystem) was positive for SARS-CoV-2 (RdRP, E, and N gene positive). In this period, the variant of the concern (VC) was primarily Wuhan SARS-CoV-2. Non-contrast computed tomography (NCCT) of the chest showed ground glass opacifications in the subpleural region, focal consolidations, and moderate pleural effusion, mostly in the lower field of the right lung (Fig. 1A, B). The patient was admitted to a single-ward hospital for the treatment of pneumonia. He received oxygen therapy, a prophylactic dose of low molecular weight heparin, ceftriaxone, and 1 unit of convalescent plasma. He finished the treatment after 13 days, obtaining the elimination of the virus confirmed by the RT-PCR test and resolution of inflammatory changes in the control NCCT (Fig. 2A, B). Due to treatment with convalescent plasma, he was not qualified for direct vaccination against SARS-CoV-2. Then, from 09/2020, due to colon cancer progression, he received the second-line palliative chemotherapy FOLFOX4 (oxaliplatin, calcium folinate, 5-fluorouracil). In April 2021, he was hospitalized in the Surgery Department to restore the continuity of the digestive tract. After the operation, the SARS-CoV-2 RT-PCR test was positive again. In this period, the British variant (Alpha)