# Triple Infections With Campylobacter coli, Cytomegalovirus, and SARS-CoV-2 in a Lymphoma Patient Treated With Epcoritamab

## TL;DR

A lymphoma patient treated with epcoritamab developed triple infections with Campylobacter coli, Cytomegalovirus, and SARS-CoV-2, highlighting risks of immune suppression from B-cell targeting therapies.

## Contribution

This case report highlights the risk of triple infections in lymphoma patients undergoing B-cell targeting therapies like epcoritamab.

## Key findings

- A patient treated with epcoritamab developed infections with Campylobacter coli, Cytomegalovirus, and SARS-CoV-2.
- The patient showed persistent SARS-CoV-2 viral shedding for six weeks after recovery from infections.
- Epcoritamab may cause prolonged B-cell depletion and potentially impact T-cell function.

## Abstract

Malignant lymphoma is a common hematological malignancy, characterized by immunocompromise due to lymphocytic dysfunction. Chemoimmunotherapy for malignant lymphoma, including corticosteroids, rituximab (R), and Bruton's tyrosine kinase inhibitors, depletes normal lymphocytes and disrupts lymphocyte function. Muchmore, various novel treatment modalities, including antibody-drug conjugates, chimeric antigen receptor T cell (CAR-T) therapy, and bispecific T-cell engager (BiTE) antibody treatments such as epcoritamab, are all utilized to target the patient’s own B lymphocytes targeted via mature B cell molecules. The latest anti-lymphoma therapy, epcoritamab, can promote CD3+ T lymphocytes to attack CD20+ normal B lymphocytes and lymphoma cells. Consequently, heavily treated lymphoma patients may experience compromised lymphocyte function. We treated a case of relapsed malignant lymphoma, infected with triple infections, Campylobacter coli, Cytomegalovirus, and SARS-CoV-2, during treatment with epcoritamab after standard chemoimmunotherapies, including R-cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP), and R-bendamustine. After three cycles of epcoritamab therapy, the patient developed moderate COVID-19 pneumonia requiring oxygen therapy. Concurrently, he had a bloodstream infection with Campylobacter coli due to Campylobacter coli enterocolitis and Cytomegalovirus antigenemia. His treatment for infections included remdesivir, meropenem, and ganciclovir. By day 12, his infectious diseases improved, and he was discharged in complete recovery. However, he had persistent SARS-CoV-2 viral shedding for six weeks or longer. Epcoritamab can demonstrate long-standing B-cell depletion; however, a long-term influence on T cells is still elusive. This case suggested that we should pay special attention to patients with B-cell manipulating therapy including R, CAR-T, and BiTEs such as epcoritamab.