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version 1 http://purl.org/np/RAb6dsUvmQwK-EWqrEMV8Rxq2QYz9szZfWh-Sq9_bvs2k#version http://www.w3.org/ns/prov#value 1 http://www.w3.org/1999/02/22-rdf-syntax-ns#object https://uts.nlm.nih.gov/uts/umls/concept/C0015219 evolution http://www.w3.org/1999/02/22-rdf-syntax-ns#object https://uts.nlm.nih.gov/uts/umls/concept/C0221198 lesions http://www.w3.org/1999/02/22-rdf-syntax-ns#object https://uts.nlm.nih.gov/uts/umls/concept/C0332468 honeycombing http://www.w3.org/1999/02/22-rdf-syntax-ns#object https://uts.nlm.nih.gov/uts/umls/concept/C0349384 honeycombing http://www.w3.org/1999/02/22-rdf-syntax-ns#predicate http://twoc-nlp-database-server-1:8555/solr/predicates/select?q=TRIPLE_UID:c4pqj8xc-TRIPLE-ABSTRACT-29 reveal http://www.w3.org/1999/02/22-rdf-syntax-ns#subject https://uts.nlm.nih.gov/uts/umls/concept/C0011777 dexamethasone http://www.w3.org/1999/02/22-rdf-syntax-ns#subject https://uts.nlm.nih.gov/uts/umls/concept/C0015133 etoposide http://www.w3.org/1999/02/22-rdf-syntax-ns#subject https://uts.nlm.nih.gov/uts/umls/concept/C0202823 CT chest http://www.w3.org/1999/02/22-rdf-syntax-ns#subject https://uts.nlm.nih.gov/uts/umls/concept/C0332283 follow http://www.w3.org/1999/02/22-rdf-syntax-ns#subject https://uts.nlm.nih.gov/uts/umls/concept/C0881858 CT chest http://www.w3.org/1999/02/22-rdf-syntax-ns#subject https://uts.nlm.nih.gov/uts/umls/concept/C1719822 follow http://www.w3.org/2000/01/rdf-schema#Triple-UID http://twoc-nlp-database-server-1:8555/solr/triples/select?q=TRIPLE_UID:c4pqj8xc-TRIPLE-ABSTRACT-29 c4pqj8xc-TRIPLE-ABSTRACT-29 http://www.w3.org/2000/01/rdf-schema#sentence http://www.w3.org/2000/01/rdf-schema#label SESSION Medical Student/Resident Lung Cancer Posters SESSION Med Student/Res Case Rep Postr PRESENTED October 18-21, 2020 The COVID-19 pandemic has set a precedent for medicine, especially vulnerable immunocompromised patients Cancer patients are facing a dilemma, uncertain of especially vulnerable immunocompromised patients Cancer patients's treatment course, and the serious risk of contracting the viral illness, all while there is no current research showing mortality rates in especially vulnerable immunocompromised patients Cancer patients Postr present a rapidly evolving undiagnosed COVID-19 patient after chemotherapy initiation for a recent lung cancer diagnosis CASE A 64-year-old Caucasian male with a history of COPD, tobacco use and a recent diagnosis of lung cancer presented to the emergency department after experiencing palpitations and 10 days of malaise and dyspnea on exertion Prior to presented, a rapidly evolving undiagnosed COVID-19 patient after chemotherapy initiation for a recent lung cancer diagnosis underwent lung cancer screening with a CT chest scan on April 19, 2020 (baseline CT chest, Figure 1) The results showed a left lower lobe mass without infiltrates, subsequently biopsied and confirmed small cell lung carcinoma Upon presentation to Postr's hospital on May 1, 2020, a rapidly evolving undiagnosed COVID-19 patient after chemotherapy initiation for a recent lung cancer diagnosis's labs were significant for – absolute lymphocyte count (745), D-dimer (4 33), NT-proBNP (2149), troponin (0 05), ALT (97), AST (87), creatinine (1 39) There was no evidence of an elevated total WBC, abnormal thyroid studies or any labs suggestive of paraneoplastic syndrome a rapidly evolving undiagnosed COVID-19 patient after chemotherapy initiation for a recent lung cancer diagnosis's initial ECG showed atrial flutter with a rapid ventricular rate CT chest showed honeycombing lesions in the central right lobe and around the left lobe near the lung mass (Figure 2) Given a rapidly evolving undiagnosed COVID-19 patient after chemotherapy initiation for a recent lung cancer diagnosis's hemodynamic instability, a rapidly evolving undiagnosed COVID-19 patient after chemotherapy initiation for a recent lung cancer diagnosis was admitted to the ICU and successfully cardioverted following a negative TEE A respiratory PCR panel returned negative on May 4 (did not include COVID-19) Chemotherapy was initiated with carboplatin, etoposide and dexamethasone A follow-up CT chest revealed evolution of the honeycombing lesions, now spread diffusely, raising concern for COVID-19 (Figure 3) A COVID-19 NAAT returned positive on May 6 This case illustrates the increased susceptibility of cancer patients to COVID-19 Given this, Postr recommend pre-emptive COVID-19 testing for all patients prior to starting any chemotherapy Secondly, This case serves as an example of the rapid evolution of COVID-19, and the benefits of repeated imaging Prior reports from Chinese patients showed bilateral infiltrates upon admission 79% of the time and median 5 days of symptom onset to admission (Zhao1) CT chest scans typically showed ground glass opacities and bilateral patchy shadowing (Guan2, Shi3) If testing is not readily available or turn-around time is prolonged, repeat CT chest scans can help guide treatment Having a baseline CT chest helped initiate testing for COVID-19 after Guan2's symptoms worsened once Guan2 received chemotherapy The evolution is rapid, requiring a high index of suspicion for diagnosis and extensive testing to monitor the course in these patients This case hopes to set a standard for similar patients Reference #1: Zhao1, Yao F, Wang L, et al A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias Clinical Infectious Diseases, ciaa247, March 12, 2020 https://academic oup com/cid/advance-article/doi/10 1093/cid/ciaa247/5803302external icon Reference #2: Guan2, Ni ZY, Hu Y, et al Clinical Characteristics of Coronavirus Disease 2019 in Chinaexternal icon N Engl J Med February 28, 2020 10 1056/NEJMoa2002032 Reference #3: Shi H, Han X, Jiang N, et al Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study The Lancet Published online February 24, 2020 https://www sciencedirect com/science/article/pii/S1473309920300864 10 1016/S1473-3099(20)30086-4 No relevant relationships by Ralph Apolinario, source=Web Response No relevant relationships by Oziel Garza de la Garza, source=Web Response No relevant relationships by James Hanley, source=Web Response No relevant relationshi s by Luyang Jin, source=Web Response No relevant relationships by Ayman Khaddam, source=Web Response No relevant relationships by Henderson Lopez, source=Web Response No relevant relationships by Jeann Maldonado Cintron, source=Web Response No relevant relationships by Earl Mejia, source=Web Response No relevant relationships by Alberto Montalvo, source=Web Response No relevant relationships by Rafael Otero, source=Web Response No relevant relationships by Nayeli Zarate, source=Web Response http://www.w3.org/2000/01/rdf-schema#triple http://www.w3.org/2000/01/rdf-schema#label etoposide and dexamethasone A follow - up CT chest revealed evolution of the honeycombing lesions 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