COVID-19 Infection Can Worsen CAD Symptoms, Report Highlights

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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COVID-19 can worsen symptoms of cold agglutinin disease (CAD), a recent case report highlights.

The scientists stressed the need for further research to determine the best ways to care for people with new or worsening CAD that develops in the context of a COVID-19 infection.

In this case, treatment with remdesivir and dexamethasone resulted in “significant improvement in the patient’s condition,” they wrote.

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The report, “Exacerbation of Secondary Cold Agglutinin Syndrome in the Setting of SARS-CoV-2,” was published in the journal Cureus.

CAD can develop or worsen in patients with an infection, in which case it is referred to as secondary CAD. In fact, known triggers of CAD are the Epstein-Barr virus, which causes infectious mononucleosis — colloquially called “mono” — and Mycoplasma pneumoniae, a bacteria involved in some lung infections.

In the new report, a team of scientists in the U.S. described the case of an 83-year-old woman with a history of secondary CAD who was treated at the hospital for shortness of breath, cough, weakness, and lightheadedness.

She also had blue discoloration of the fingers and toes, known as acrocyanosis, and jaundice, or yellowing of the skin, as well as darkened urine.

The patient did not have a fever and reported no chest pain. Nonetheless, she had severe hypoxia, or low blood oxygen levels, as well as severe anemia.

Lab tests came back positive for cold agglutinins — the self-targeting antibodies that cause CAD. The patient also tested positive for SARS-CoV-2, the virus that causes COVID-19.

“After careful investigation and consideration for other causes of severe shortness of breath and hypoxia, the diagnosis of cold agglutinin hemolytic anemia exacerbation secondary to COVID-19 infection was confirmed,” after a series of other tests, the researchers wrote.

“COVID-19 infections, similar to infections with Epstein-Barr virus and Mycoplasma pneumoniae, may be an independent risk factor predisposing individuals to the exacerbation of [secondary CAD], they wrote.

The patient was treated with antiviral therapy and steroids — specifically remdesivir and dexamethasone — for COVID-19, as well as with other treatments to control individual symptoms. For example, she was given blood transfusions for anemia.

The woman’s condition gradually improved, and she was discharged from the hospital just over a week after first testing positive for COVID-19. Two days later, she was re-hospitalized because of worsening anemia. She was given additional blood transfusions, as well as steroids and other immune-suppressing medications, and was discharged again eight days later once anemia had eased.

This case, according to the researchers, highlights the need for new insights into treating patients with CAD that is new or worsens after a COVID-19 infection.

“The lack of established evidence-based treatments for the disorder warrants further research in this area of medicine,” the team wrote.