A Diagnostic Dilemma of Encephalopathy in Acute Myeloid Leukemia Patient with Twice COVID-19 Infection: A Case Report

Alghandour, Reham; El-Ashwah, Shaimaa; Emarah, Ziad; Elashwah, Salma; Saleh, Layla M.; Elmaria, Marwa O.; Ebrahim, Mohamed A.; ElKhodary, Tawfik; Saleh, Gehad A.; EL-Sheltawy, Nada F.; Zaki, Heba; Shamaa, Sameh

doi:10.21608/resoncol.2022.167065.1176

A Diagnostic Dilemma of Encephalopathy in Acute Myeloid Leukemia Patient with Twice COVID-19 Infection: A Case Report

Document Type : Case reports

Authors

¹ Department of Medical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

² Department of Clinical Hematology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

³ Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

⁴ Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt

⁵ Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

10.21608/resoncol.2022.167065.1176

Abstract

Background: During the COVID‐19 pandemic, there was limited data about the appropriate management of acute myeloid leukemia (AML) with COVID-19 infection and the possible post-COVID-19 complications reported in acute leukemia patients.
Case presentation: We report a 52-year-old lady with AML and confirmed twice SARS-CoV-2 infection. The first infection was just after the diagnosis of AML before the administration of induction therapy, and the second infection was just after she received the salvage therapy. The COVID-19 infection was confirmed by qRT-PCR and high-resolution non-contrast computerized tomography of the chest. Unfortunately, the patient developed post-covid neurological complications, disturbed consciousness level, and encephalopathy. The COVID-19 infection may have triggered encephalopathy or exaggerated the neurological toxicity of cytarabine even in a small dose. Another possible explanation is the exaggeration of cytokine storm by the administration of granulocyte-stimulating factors used in salvage therapy.
Conclusion: Management of COVID-19 infection in AML patients faces many challenges. These patients are more vulnerable and susceptible to many complications and high mortality rates. The treatment approach needs to be tailored to overcome the interaction between the treatment adverse events and the biology of covid-19 infection.

Keywords