CASE DESCRIPTION
A 15-year-old male receiving cyclosporine for AA was admitted to the
University of Tokyo Hospital due to fever. He was diagnosed with severe
AA four months ago. Since a human leukocyte antigen-matched sibling
donor was unavailable, he received IST with corticosteroids, rabbit
antithymocyte globulin, and cyclosporine combined with eltrombopag. He
was discharged and barely achieved a partial response two months after
IST initiation (Fig. 1). At the time of his hospitalization, he
presented with a fever (39.2˚C) and mild sore throat that was noted one
day previously. His white blood cell count was 1.0 ×
109/L, with absolute neutrophil and lymphocyte counts
of 0.67 × 109/L and 0.18 × 109/L,
respectively. The hemoglobin level was 9.8 g/dL, and the platelet count
was 45 × 109/L without transfusion for more than two
months. The serum IgG level was low at 503 mg/dL (reference value,
861–1747 mg/dL). Other blood examinations were unremarkable. The chest
radiograph did not show any evidence of pneumonia.
On day 2 (the onset of COVID-19 was considered day 0), the patient
tested positive on nasopharyngeal swab polymerase chain reaction testing
for SARS-CoV-2. As a part of IST, cyclosporine was continued with trough
concentrations of 150–250 ng/mL. After receiving intravenous
immunoglobulin and a single dose of hydrocortisone, he became afebrile
on day 2. Although the complete blood count fluctuated slightly, he did
not require transfusion or granulocyte-colony stimulating factor. He was
discharged on day 10 without sequelae attributed to COVID-19 for four
months.