A fatal case of COVID-19 breakthrough infection due to the delta variant

A 61-year-old man with a history of arterial hypertension (PA 145/95 mmHg) and obesity with a body mass index (BMI) of 37.11 was vaccinated with a double dose of mRNA vaccine, but 4 months after the 2nd dose presented with dyspnea, cough, and fever (38°C). Four days after his nasopharyngeal/oropharyngeal (NP/OP) swabs tested positive for SARS-CoV-2 he came to the emergency room with a saturation oxygen level (SO2) at 84%. He continued to test positive for SARS-CoV-2 on NP/OP swabs with detection of the delta variant. Laboratory examination showed a high white blood count, elevated lactated dehydrogenase enzyme (LDH) (750 U/L), elevation of the C-reactive protein (CRP) (26.3 mg/dl), and a mild elevation of the liver aspartate aminotransferase (AST) (61 U/L) (normal value 0–34 U/L). A chest CT scan showed a typical central and peripheral distribution of GGO COVID-19 pneumonia (CT-SS score of 16/20). The other laboratory values were in the normal range. Teh serology, performed with an immunoassay (Liaison XL), confirmed the presence of SARS-CoV-2 S1/S2 IgM associated with SARS-CoV-2 anti-spike IgG (2080 BAU/ml) related to the previous vaccination and was high enough to align with cases with positive outcome as previously reported. The treatment started with dexamethason and low molecular weight heparin (like in another breakthrough case). Two days later his clinical condition worsened with SO2 at 74%, the D-dimer level increased, and chest CT-scan score mildly worsened to 18/20 (see figure above). No major pulmonary embolism was visible on the pulmonary artery angiography image. However, the patient died 9 days later. 


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REFERENCE

Bignardi, E, Brogna, C, Capasso, C, Brogna, B. A fatal case of COVID-19 breakthrough infection due to the delta variant. Clin Case Rep. 2022; 10:e05232. doi:10.1002/ccr3.5232


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