# A Patient With Three Types of Hematologic Disorders and Hemophagocytic Lymphohistiocytosis Triggered by SARS-CoV-2: A Case Report

## TL;DR

A patient with multiple hematologic disorders developed severe complications from SARS-CoV-2 and later chronic myeloid leukemia, highlighting the risks of long-term immune suppression.

## Contribution

This case report highlights the rare occurrence of three hematologic malignancies and HLH triggered by SARS-CoV-2 in a patient with a history of lymphoma.

## Key findings

- A patient with follicular lymphoma later developed mantle cell lymphoma and chronic myeloid leukemia.
- SARS-CoV-2 infection triggered hemophagocytic lymphohistiocytosis in an immunocompromised patient.
- Early intervention and treatment with flumatinib improved the patient's condition.

## Abstract

Second primary malignancy is a serious late complication following anti-cancer treatments including chemotherapies, immune therapies, and radiotherapies. Prolonged use of rituximab-containing immunochemotherapies in patients with non-Hodgkin lymphoma can impair immune surveillance, potentially increasing the risk of severe infections and second primary malignancies. Here, we report the case of a patient initially diagnosed with follicular lymphoma, who then developed mantle cell lymphoma 11 years later. After several rounds of rituximab-containing therapies, the patient had impaired immunity and experienced severe SARS-CoV-2 pneumonia and hyperleukocytosis, which induced the hyperinflammatory responses, resulting in hemophagocytic lymphohistiocytosis (HLH). Early intervention halted the progression of HLH; however, leukocytosis and thrombocytosis recurred, eventually leading to the diagnosis of a third hematologic malignancy - chronic myeloid leukemia. Treatment with flumatinib improved the patient’s condition. This case underscores the importance of monitoring immune depression and subsequent malignancies as more patients achieve long-term survival with hematologic cancers due to evolving therapeutic advances. Early recognition and adequate supportive therapies are crucial, especially in managing elderly patients with malignancies.