COVID-19 in a patient with advanced Merkel cell carcinoma receiving immunotherapy

Immunotherapy. 2020 Oct;12(15):1133-1138. doi: 10.2217/imt-2020-0193. Epub 2020 Sep 9.


Background: Little is known about the 2019 novel coronavirus disease (COVID-19) course and outcomes in patients receiving immunotherapy. Here we describe a metastatic Merkel cell carcinoma patient with a severe acute respiratory syndrome coronavirus 2 infection while receiving pembrolizumab. Case presentation: A 66-year-old man, with a metastatic Merkel cell carcinoma receiving pembrolizumab, presented with fever. Chest computed tomography (CT) showed pulmonary ground-glass opacities, suggesting viral or immuno-related etiology. On day 7, the patient was hospitalized due to dyspnea and worsening of the radiological findings. Real time polymerase chain reaction (RT-PCR) testing confirmed COVID-19. The patient developed acute respiratory distress syndrome and acute kidney injury. Hydroxychloroquine was administered for 5 days, but discontinued after supraventricular extrasystoles. Clinical improvement allowed the patient's discharge after 81 days of hospitalization. Conclusion: A careful evaluation of oncologic patients receiving immunotherapy during the COVID-19 pandemic is of utmost importance.

Keywords: COVID-19; Merkel cell carcinoma; SARS-CoV-2; anti-PD-1 therapy; coronavirus; immune-related adverse events; immunotherapy; oncology; pandemic; skin cancer.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents, Immunological / therapeutic use
  • Betacoronavirus
  • COVID-19
  • Carcinoma, Merkel Cell / complications
  • Carcinoma, Merkel Cell / pathology
  • Carcinoma, Merkel Cell / therapy*
  • Coronavirus Infections / complications
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / pathology
  • Coronavirus Infections / therapy
  • Humans
  • Immunotherapy* / adverse effects
  • Lung / diagnostic imaging
  • Lung / pathology
  • Male
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / therapy
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors
  • SARS-CoV-2
  • Skin Neoplasms / complications
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • Programmed Cell Death 1 Receptor
  • pembrolizumab