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COVID-19: Spleen Involvement or Coincidence

Magda Costa, Mariana Formigo, Isabel Bessa, Helena Sarmento, Jorge Cotter

A 62-year-old man presented a history of fever, cough, left thoracic pain, left hypochondrium discomfort, asthenia and anorexia for the past week. He had lost 6 Kg in the past month. His TAP CT revealed extensive densification of the left lung lower lobe and a spleen enlargement of 22 cm in its longitudinal axis. He presented anaemia, lymphopenia, elevated CRP and LDH. He had a SARS-CoV-2 positive test, Streptococcus pneumoniae positive urinary serology and blood culture. 20 days later he repeated his TAP CT showing pneumonia imaging evolution and a 21 cm spleen longitudinal axis and one month later he repeated an abdominal US revealing a 17.7 cm diameter spleen. HBV, HCV, HIV, EBV and CMV serologies were negative. Bone marrow immunophenotyping suggested splenic marginal zone lymphoma.