LAUSR

Novel coronavirus pneumonia, named coronavirus disease 2019 (COVID-19), is an infection related to the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Initial studies indicated that patients have a dysregulated immune response associated with lymphopenia.1,2 Here, we report a case of rapid rise of a CLL clone quickly after admission of the patient for COVID-19. An 83-year-old man (BMI 27.6) with a medical history of radiotherapy treated pulmonary neoplasia in 2018 was referred for 2 days of fever, nonproductive cough, dyspnea, and rectal bleeding. Initially, the most relevant clinical findings were body temperature of 39.1°C, white blood cell counts 3.16 × 109/L, lymphocytes 1.2 × 109/L, hemoglobin 120 g/L, platelet count 92 × 109/L, D-Dimer 1290 ng/ mL, and C-reactive protein (CRP) 34 mg/L (Table S1). A CT-scan of the chest showed bilateral ground-glass opacities and peripheral linear condensations associated with retroperitoneal and mesenteric adenopathy. RT-PCR assay result was positive for SARS-CoV-2. He started supportive care with paracetamol associated with amoxicillin and clavulanic acid, due to increased CRP. On D8, worsening pulmonary signs resulted in the delivery of 1.5-5 L/min of oxygen. At D11, increased number of circulating B cells (more than 0.5 × 109/L) triggered a complete immunophenotype. It identified a small CD5+ CLL-type clone (MATUTES score 5/5) measuring only 0.48 × 109/L