Abstract Rationale: Viruses are the most common pathogens that can cause infection-related non-recurrent death after transplantation, occurring mostly from the early stages of hematopoietic stem cell transplantation (HSCT) to within 1 year after transplantation. Human coronavirus (HCoV)-NL63 is a coronavirus that could cause mortality among patients with underlying disease complications. Serological tests are of limited diagnostic value in immunocompromised hosts and cases of latent infection reactivation. In contrast, macro-genomic high-throughput (DNA and RNA) sequencing allows for rapid and accurate diagnosis of infecting pathogens for targeted treatment. Patient concerns: In this report, we describe a patient who exhibited acute B-lymphocytic leukemia and developed complicated pulmonary HCoV-NL63 infection after a second allogeneic HSCT (allo-HSCT). Six months after the second allo-HSCT, he developed sudden-onset hyperthermia and cough with decreased oxygen saturation. Chest computed tomography (CT) suggested bilateral multiple rounded ground-glass opacities with the pulmonary lobules as units. Diagnoses: HCoV-NL63 was detected by metagenomic next-generation sequencing (NGS), and HCoV-NL63 viral pneumonia was diagnosed. Interventions: The treatment was mainly based on the use of antiviral therapy, hormone administration, and gamma-globulin. Outcomes: After the therapy, the body temperature returned to normal, the chest CT findings had improved on review, and the viral copy number eventually became negative. Lessons: The latest NGS is an effective method for early infection diagnosis. The HCoV-NL63 virus can cause inflammatory factor storm and alter the neutrophil-to-lymphocyte ratio (NLR). This case suggests that the patient’s NLR and cytokine levels could be monitored during the clinical treatment to assess the disease and its treatment outcome in a timely manner.
【저자키워드】 complications, human coronavirus NL63, acute B-lymphocytic leukemia, high-throughput sequencing of infectious pathogen macrogenome, post-second allogeneic hematopoietic stem cell transplantation, 【초록키워드】 Treatment, serological test, antiviral therapy, coronavirus, Treatment outcome, therapy, Mortality, Human, Sequencing, NGS, Infection, Diagnosis, underlying disease, cough, virus, Neutrophil-to-lymphocyte ratio, Computed tomography, Viral pneumonia, ground-glass opacity, oxygen saturation, Chest CT, pathogen, Next-generation sequencing, Patient, death, Immunocompromised, early stage, body temperature, leukemia, HCoV-NL63, NLR, administration, Inflammatory, Clinical treatment, early infection, HSCT, Stem cell transplantation, diagnostic value, Host, Alter, DNA and RNA, effective, allo-HSCT, allogeneic HSCT, the patient, diagnosed, the disease, exhibited, suggested, returned, cytokine level, infecting pathogen, metagenomic, pulmonary lobule, 【제목키워드】 Infection, Case report, Allogeneic, leukemia, Stem cell transplantation,