images in haematology
SARS-CoV-2-induced remission of Hodgkin lymphoma
A 61-year-old man was referred to the haematology depart-
ment with progressive lymphadenopathy and weight loss. He
was receiving haemodialysis for end-stage renal failure sec-
ondary to IgA nephropathy. He had been off immunosup-
pressive therapy for three years after a failed renal transplant.
Needle-core biopsy of a supraclavicular node demonstrated
Epstein–Barr virus (EBV)-positive classical Hodgkin lym-
phoma [EBV viral polymerase chain reaction (PCR) 4800
copies/ml; log10 3
68]. Fluorodeoxyglucose-positron emission
tomography/computed tomography (FDG-PET/CT) revealed
avid stage IIIs disease (left image, PET scan, and supplemen-
tary image PET/CT). Shortly after diagnosis he was admitted
with breathlessness and wheeze and was diagnosed with
PCR-positive SARS-CoV-2 pneumonia. After 11 days of best
supportive ward-based care he was discharged to convalesce
at home. No corticosteroid or immunochemotherapy was
administered.
Four months later, palpable lymphadenopathy had
reduced and an interim PET/CT scan revealed widespread
resolution of the lymphadenopathy and reduced metabolic
uptake throughout (right image and supplementary image).
The EBV viral PCR had also fallen to 413 copies/ml (log10
2
62).
ª 2020 British Society for Haematology and John Wiley & Sons Ltd
We hypothesise that the SARS-CoV-2 infection triggered
an anti-tumour immune response, as has been described with
other infections in the context of high-grade non-Hodgkin
lymphoma.1 The putative mechanisms of action include
cross-reactivity of pathogen-specific T cells with tumour anti-
gens and natural killer cell activation by inflammatory
cytokines produced in response to infection.
Sarah Challenor and David Tucker
Department of Haematology, Royal Cornwall Hospital, Truro, UK.
E-mail: sarahchallenor@nhs.net
Supporting Information
Additional supporting information may be found online in
the Supporting Information section at the end of the article.
Reference
1. Buckner TW, Dunphy C, Fedoriw YD, van Deventer HW, Foster MC,
Richards KL, et al. Complete spontaneous remission of diffuse large B-cell
lymphoma of the maxillary sinus after concurrent infections. Clinical Lym-
phoma, Myeloma & Leukemia. 2012;12:455–8.
doi: 10.1111/bjh.17116