Haemodialysed patient with lung cancer in the COVID-19 era:
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COVID-19, caused by the SARS-CoV-2, was considered pandemic in March 2020. One year later, more than 120 million cases had been reported across the world, and more than 2.5?million people died. In January 2021, Portugal became one of the most affected countries worldwide concerning the number of new cases per million inhabitants, exceeding 16 000 daily cases.

Patients with lung cancer, given their commitment to underlying lung function, represent a particularly vulnerable group to COVID-19. Furthermore, the most common symptoms of COVID-19 and lung cancer, such as cough and dyspnoea, can overlap, thus delaying diagnosis. The most common imagiological changes of COVID-19 can also be confused with those caused by pneumonitis associated with immunotherapy, tyrosine kinase inhibitors (TKIs), and radiotherapy (RT).

A 66-year-old man was referred to the oncological pneumology consultation due to a mass in the right upper lobe observed in a routine X-ray of the chest. The CT scan confirmed a mass in the same location. The biopsy revealed a lung adenocarcinoma. It was decided to start chemotherapy adapted to kidney function. In April 2020, the patient contracted SARS-CoV-2 infection and developed bilateral pneumonia with partial respiratory failure.

He was transferred to the intensive care unit, where he had a positive evolution. In the next 5 months, there was a clinical improvement; however, the CT scan of the chest showed disease progression. After a new multidisciplinary approach, it was decided to start a second line with atezolizumab. After four cycles of atezolizumab, there was a clear clinical improvement, and a reduction by more than 50% in the tumour size, without significant adverse effects.

Source: https://casereports.bmj.com/content/14/7/e243462?rss=1