COVID-19 infection in patients with Sézary syndrome: report of three cases

INTRODUCTION: A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread worldwide during 2020, was declared as a public health emergency and potentially life-threatening. Patients with hematologic malignancies may have an increased risk of severe COVID-19, due to immunosuppression related to the underlying disease and its treatment. In the absence of specific data, potential risk factors for severe events of COVID-19 should be considered as for other community acquired respiratory virus (CARV) infections: >60 years, severe immunodeficiency, chemotherapy treatment. We present three patients with Sézary syndrome (SS) and COVID-19 infection. OBJECTIVE: We aim to report the outcome of COVID-19 in patients with SS treated at the department of Dermatology of the Hospital Italiano de Buenos Aires. METHODS AND MATERIAL: Patients with SS who were diagnosed positive for COVID19 infection, during worldwide pandemic in 2020. We collected retrospectively clinical data, SS evolution and treatment response. CASE 1: A 58-year-old male with hypertension was diagnosed with SS stage IVA1 in July 2014, he received multiple systemic treatments such as extracorporeal photopheresis (ECP), IFN 2b, bexarotene, with partial response (PR) and eventually stable disease. In August 2020, he was hospitalized due to fever, dry cough and progressive cutaneous disease. SARS-CoV2 was confirmed, requiring invasive mechanical ventilatory (IMV) in the ICU and systemic corticosteroids. The clinical course improved with complete response (CR) of cutaneous disease and persistence of hematologic involvement. He was discharged 3 months later with no SARS-CoV-2 sequels. CASE 2: A 66-year-old female with breast cancer in 2002 treated with RT and tamoxifeno was diagnosed with SS stage IVA1 in March 2012. She was treated with IFN 2b, TSEB, vorinostat and ECP with CR, relapse and then PR. In November 2020 she started chemotherapy due to cutaneous and nodal progression. A month later, she required hospitalisation and IMV due to dry cough and respiratory distress, SARS-CoV-2 was confirmed. She died 7 days later due to progression of respiratory distress. CASE 3: An 86-year-old male with arterial hypertension was diagnosed with SS stage IVA1 in March 2017. He received ECP, methotrexate, with PR. In February 2021 he was hospitalized due to dry cough, headache with cutaneous disease relapse. Laboratory parameters showed pre-existing lymphopenia. SARS CoV-2 was confirmed. He was admitted to the ICU requiring IMV due to respiratory distress, and died 15 days after. CONCLUSIONS: Among our patients, two had several associated comorbidities and risk factors for a severe event of COVID-19, besides case 3 presented pre-existing lymphopenia at presentation. Case 1, despite his comorbidities and IMV, developed a favorable clinical course. To our knowledge there are many unknown factors and limited published studies, describing COVID-19 outcomes in patients with SS, most of them based on case reports.