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.