• Zhihui Li, Shuo Meng, Qinlong Zheng, and Tong Wu.
• Department of Bone Marrow Transplantation.
• Medicine (Baltimore). 2021 Jun 25; 100 (25): e26446e26446.

RationaleViruses are the most common pathogens that can cause infection-related non-recurrent death after transplantation, occurring mostly from the early stages of hematopoietic stem cell transplantation (HSCT) to within 1 year after transplantation. Human coronavirus (HCoV)-NL63 is a coronavirus that could cause mortality among patients with underlying disease complications. Serological tests are of limited diagnostic value in immunocompromised hosts and cases of latent infection reactivation. In contrast, macro-genomic high-throughput (DNA and RNA) sequencing allows for rapid and accurate diagnosis of infecting pathogens for targeted treatment.Patient ConcernsIn this report, we describe a patient who exhibited acute B-lymphocytic leukemia and developed complicated pulmonary HCoV-NL63 infection after a second allogeneic HSCT (allo-HSCT). Six months after the second allo-HSCT, he developed sudden-onset hyperthermia and cough with decreased oxygen saturation. Chest computed tomography (CT) suggested bilateral multiple rounded ground-glass opacities with the pulmonary lobules as units.DiagnosesHCoV-NL63 was detected by metagenomic next-generation sequencing (NGS), and HCoV-NL63 viral pneumonia was diagnosed.InterventionsThe treatment was mainly based on the use of antiviral therapy, hormone administration, and gamma-globulin.OutcomesAfter the therapy, the body temperature returned to normal, the chest CT findings had improved on review, and the viral copy number eventually became negative.LessonsThe latest NGS is an effective method for early infection diagnosis. The HCoV-NL63 virus can cause inflammatory factor storm and alter the neutrophil-to-lymphocyte ratio (NLR). This case suggests that the patient's NLR and cytokine levels could be monitored during the clinical treatment to assess the disease and its treatment outcome in a timely manner.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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