COVID-19 pneumonia in a multiple sclerosis patient with severe lymphopenia due to recent cladribine treatment

Mult Scler. 2020 Sep;26(10):1264-1266. doi: 10.1177/1352458520943783. Epub 2020 Aug 7.

Abstract

Background: Most cases of COVID-19 are considered mild, but patients with immunosuppressant treatment might be prone to severe courses of disease. Expert panels advise to delay treatment with cell-depleting MS therapies during the COVID-19 pandemic.

Methods: We report a case of a patient with relapsing-remitting multiple sclerosis who developed COVID-19 pneumonia 2 weeks after the first week of cladribine therapy.

Results: Despite a severe lymphopenia (absolute lymphocyte count 240/µL), the patient had a moderate course of COVID-19.

Conclusion: Apart from maximal supportive treatment, this could be due to cladribine reducing inflammatory response, which probably contributes considerably to severe courses of COVID-19 pneumonia.

Keywords: COVID-19; Multiple sclerosis; cladribine; prognosis.

Publication types

  • Case Reports

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Cladribine / adverse effects*
  • Coronavirus Infections / complications
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / physiopathology
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Lymphopenia / chemically induced*
  • Lymphopenia / immunology
  • Male
  • Middle Aged
  • Multiple Sclerosis, Relapsing-Remitting / complications
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / physiopathology
  • SARS-CoV-2
  • Severity of Illness Index

Substances

  • Immunosuppressive Agents
  • Cladribine