aeruginosa, successfully treated with piperacillin/tazobactam. A repeated SPEP showed a significant decrease in M-protein, in parallel with reduction of inflammatory biomarkers and lymphocyte reconstitution. Steroid treatment was added, and non-invasive ventilation was necessary from D17 to D21, when initial improvement in his respiratory status was observed. A monoclonal band was found on SPEP and it was characterized as IgG-lambda by immunofixation. Prothrombin time was slightly prolonged (14.1 s), whereas platelet count (489 × 10 9 L –1) and fibrinogen (>900 mg/dL) were increased. At D9 blood tests revealed lymphopenia (740 μL −1), increased LDH (809 UI/L), ferritin (1879 ng/mL), and CRP (17.6 mg/dL). Treatment with hydroxychloroquine, lopinavir/ritonavir and antibiotics was given, with no significant improvement. Chest high-resolution computed tomography (HRCT) revealed bilateral ground-glass opacities and interlobular septal thickening. His nasopharyngeal swab was positive for SARS-CoV-2 RNA. He was admitted to our COVID ward because of fever, malaise and increasing dyspnea. He had no previous evidence of monoclonal gammopathy and his serum protein electrophoresis (SPEP) was normal 9-month before. 3, 4 Whether this cell population is related to polyclonal or monoclonal hypergammaglobulinemia is still unknown.ĭuring SARS-CoV-2 outbreak in our region, we observed the case of an 80-year old man with severe COVID-19 and evidence of a transient monoclonal gamma-globulin spike ( Figure 1, case 1). 1 Though numerically depleted, circulating reactive lymphocytes were detectable in a consistent proportion of patients, some of them with a lymphoplasmacytic phenotype. 2 Lymphopenia has been identified as a prognostic marker for poor outcomes as it could be in correlation with cytokine storm. 1 Several quantitative and functional abnormalities in lymphocyte populations have been reported in patients with SARS-CoV-2 infection, with evidence of depletion of cytotoxic T-lymphocytes and natural killer cells. Laboratory findings in severe coronavirus disease (COVID)-19 may include lymphopenia, elevated D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP), and ferritin.
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