Results/Case Presentation
A 61-year-old Caucasian male veteran developed diarrhea, flushing,
pruritis, and abdominal pain in June, 2019. Computerized tomography
scans showed a jejunal mass and liver lesions. Liver biopsy confirmed
well differentiated neuroendocrine tumor. Blood counts and chemistries
were normal, but serotonin was 1246ng/mL (normal 50-200ng/mL),
chromogranin A 781ng/L (normal <39ng/L) and 24 hour urine
5-hydroxyindoleacetic acid was 91mg (normal <6mg). He was
treated with lanreotide 120mg subcutaneously weekly and everolimus 10mg
orally daily. He did well until June 27, 2020 when he noted mild
lightheadedness, nausea, cough, headache, clear sputum production,
hypogeusia, and anosmia and had a positive SARS-CoV-2 nasal swab RT-PCR
test (Table 1). He remained at home, and his symptoms resolved within
several days. However, his RT-PCR assay remained positive repeatedly for
52 days (Table 1). Because of hospital restrictions at the time on
RT-PCR positive patients, he was unable to receive his monthly clinic
lanreotide injections. His carcinoid symptoms recurred, and he required
breakthrough octreitide acetate 200mcg subcutaneous injections every 8
hours at home. To facilitate viral RNA clearance, we elected to try
pegylated interferon alpha-2a as treatment for both his neuroendocrine
tumor and his COVID-19. After informed consent and approval by the West
Palm Beach VA Medical Center Administration, Pharmacy and Research &
Education Committee, the patient received four weekly subcutaneous
injections of 90 mcg pegylated interferon-α-2a. His RT-PCR rapidly
cleared within one week of treatment, and he was able to resume
somatostatin analogue therapy at the oncology clinic. Initial anti-N
SARS-CoV-2 IgG and IgM antibodies were absent from his blood (IgG 0.03
and IgG 0.02), but by January, 2021 he had measurable antibodies (IgG
2.07 and IgM 2.18). He remained asymptomatic and is undergoing
additional treatments for his metastatic neuroendocrine tumor.