Rare Case of Persistently Depressed T Lymphocyte Subsets After SARS-CoV-2 Infection

Patient: Male, 82-year-old Final Diagnosis: A rare case of persistently depressed T lymphocyte subsets post COVID-19 infection Symptoms: Shortness of breath Medication:— Clinical Procedure: — Specialty: Immunology • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: On rare occasions, viral infections are known to also depress immune cell lines, further worsening clinical outcomes. We describe a patient who presented 3 weeks after recovery from mild COVID-19 disease with clinical features of an atypical pneumonia and was found to have a low CD4(+) T-cell count. CASE REPORT: An 82-year-old man with a past medical history of coronary artery disease, rheumatoid arthritis, gout, hyper-tension, and atrial fibrillation presented with a 1-week history of progressively worsening shortness of breath and cough. He was noted to have recovered from mild SARS-CoV-2 infection 3 weeks prior to his current presentation and had been at his baseline level of health following infection. A T cell subset panel was obtained, which revealed an absolute CD3 count of 92 (reference range 840–3060), absolute CD4 count of 52 (reference range 500–1400), absolute CD8 count of 37 (reference range 180–1170), and a normal CD4: CD8 ratio. He was subsequently started on atovaquone for pneumocystis jiroveci pneumonia prophylaxis. CONCLUSIONS: This case highlights the need for a high index of suspicion for lymphocyte depletion in older patients with multiple comorbidities who present during or after SARS-CoV-2 infection with atypical symptoms that are suggestive of immunosuppression. In such instances, there should be a low threshold to start prophylactic therapy for possible opportunistic infections.