Anales de la RANM

285 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 SARS-COV-2 INFECTION IN A PATIENT WITH PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA Pablo Estival An RANM · Año 2020 · número 137 (03) · páginas 281 a 285 Conversely, these treatments interfere with the innate immune response by blocking complement activation, which facilitates certain infections, particularly those caused by encapsulated bacteria. In fact, when receiving eculizumab or ravulizumab treatment, Neisseria meningitidis vaccination is compulsory, and prophylactic antibiotic therapy is recommendable (9). On the other hand, higher susceptibility to viral infections has not been shown to be associated with complement blockade, but an increase in upper respiratory tract infection has been reported in these patients (9). In spite of being a high-risk subject, our patient developed only mild symptoms, and eventual clinical resolution, not needing standard SARS-CoV-2 disease treatment, nor any other special care. It is possible that ravulizumab treatment played a beneficial role in his favorable development, in the same way as described by Diurno and Giudice (7,8). Kulasekararaj reported 4 PNH patients with SARS-CoV-2 infection whom 2 of them were treated with C5 blockade (one under ravulizumab and the other one with eculizumab) with a favorable outcome similar to our patient (10). Three clinical trials (CORIMUNO19-ECU; NCT04355494; and NCT04369469.) have been initiated, as well as an expanded access program (NCT04288713) to determine if COVID-19 patients treated with a terminal complement inhibitor have a better outcome or less clinical complications than patients who received standard of care. The authors would like to thank F. Javier Martín MD. for his work in the emergency room, and Scott Rottinghaus and Kenneth Pomerantz for contribu- tions to the overall study. 1. Muntañola A, Villacampa G, Hernández-Rivas JA, et al . Clinical characteristics and outcome of SARS-CoV-2 infection in admitted patients with chronic lymphocytic leukemia from a single Euro- pean country. Exp Hematol Oncol 2020; 9: 37. doi 10.1186540164-020-00195-x 2. Kulasekararaj AG, Hill A, Rottinghaus ST, et al. Ravulizumab (ALXN1210) vs eculizumab in C5-inhibitor–experienced adult patients with PNH: the 302 study. Blood. 2019; 133(6): 540–549. 3. Cheng Z, Shan J. 2019 Novel coronavirus: where we are and what we know. Infection. 2020;48(2):155-163 4. Mehta P, McAuley D, Brown M, Sanchez E, Tat- tersall R, Manson J. COVID-19: consider cytokine storm syndromes and immunosuppression. Lan- cet. 2020; 395(10229):1033-1034. 5. Zhang Z, Fan H, Jiang M, Zeng Y, Qiu X, Yang C. Coronavirus disease 2019: a clinical review. Eur Rev Med Pharmacol Sci. 2020; 24: 4585-4596. 6. Gralinski , Sheahan TP, Morrison TE, et al. Com- plement activation contributes to severe acute respiratory syndrome coronavirus pathogenesis. mBio 2018; 9: e01753-18. 7. Diurno F, Numis FG, Porta G, et al. Eculizumab treatment in patients with COVID-19: preliminary results from real life ASL Napoli 2 Nord Experien- ce. Eur Rev Med Pharmacol Sci. 2020; 24(7):4040- 4047. 8. Giudice V, Pagliano P, Vatrella A, Masullo A, Poto S, Polverino BM. Combination of ruxolitinib and eculizumab for treatment of severe SARS-CoV- 2-related acute respiratory distress syndrome: A Controlled Study. Front Pharmacol. 05 June 2020. https://doi.org/10.3389/fphar.2020.00857 9. McKeage K. Ravulizumab: First Global Approval. Drugs. 2019 ;79(3):347-352. 10. Kulasekararaj A, Lazana I, Large J et al. Termi- nal complement inhibition dampens the inflam- mation during COVID‐19. Br J Haematol. 2020; doi:10.1111/bjh.16916. F.A.G. have received honoraria and consulting fees from Alexion Pharmaceuticals, Inc. BIBLIOGRAPHY ACKNOWLEDGMENTS CONFLICT OF INTEREST STATEMENT If you want to quote our article: Estival P. SARS-CoV-2 Infectioninapatientwithparoxysmalnocturnalhaemoglobinuria ANALES RANM [Internet]. Real Academia Nacional de Medicina de España; An RANM · Año 2020 · número 137 (03) · páginas 281 – 285 DOI: 10.32440/ar.2020.137.03. cc01