BOSTON, February 10, 2026 — A lymphoma patient undergoing treatment with epcoritamab simultaneously contracted three infections – Campylobacter coli, cytomegalovirus (CMV), and SARS-CoV-2 – highlighting the heightened vulnerability of immunocompromised individuals to multiple pathogens.
Complex Case Reveals Risks for Immunocompromised Patients
The rare triple infection underscores the challenges in managing infectious diseases in patients with weakened immune systems, particularly those receiving novel cancer therapies.
- A 64-year-old male with diffuse large B-cell lymphoma developed concurrent infections with Campylobacter coli, CMV, and SARS-CoV-2.
- The patient was receiving epcoritamab, a novel T-cell engaging bispecific antibody, for lymphoma treatment.
- The case emphasizes the importance of vigilant monitoring for opportunistic infections in patients undergoing immunomodulatory therapies.
- Successful treatment involved targeted antiviral and antibiotic interventions, alongside continued cancer therapy.
The convergence of these three infections in a single patient is unusual, and the case report details the diagnostic and therapeutic journey. Understanding these complex interactions is crucial for optimizing care for vulnerable populations.
Patient History and Initial Presentation
The 64-year-old male had a history of diffuse large B-cell lymphoma, initially diagnosed in November 2023. After failing first-line chemotherapy, he began treatment with epcoritamab in January 2024. Shortly after initiating the new therapy, the patient presented with fever, diarrhea, and cough on February 15, 2024. Initial investigations revealed a positive SARS-CoV-2 PCR test, leading to isolation and supportive care.
Diagnostic Challenges and Concurrent Infections
Despite initial treatment for COVID-19, the patient’s symptoms persisted. Further testing uncovered the presence of Campylobacter coli in stool samples and evidence of CMV reactivation through quantitative PCR. The patient’s CD4+ T-cell count was notably low at 110 cells/µL, indicating significant immunosuppression. The confluence of these infections presented a diagnostic challenge, requiring a comprehensive approach to identify and address each pathogen.
Q&A: What makes this case particularly noteworthy? This case is remarkable because it demonstrates the potential for multiple, simultaneous infections in a patient with lymphoma undergoing treatment with epcoritamab, a therapy that suppresses the immune system. This highlights the need for heightened vigilance and broad diagnostic testing in similar cases.
Treatment and Clinical Outcome
Treatment involved a combination of interventions. The patient received intravenous meropenem for Campylobacter coli, ganciclovir for CMV reactivation, and continued supportive care for COVID-19. Remarkably, the patient responded well to treatment, with resolution of fever, diarrhea, and cough. Epcoritamab therapy was temporarily held but resumed after clinical improvement, demonstrating the feasibility of continuing cancer treatment alongside infection management.
Implications for Clinical Practice
This case underscores the importance of considering multiple pathogens in immunocompromised patients presenting with infectious symptoms. Broad-spectrum diagnostic testing, including stool studies, viral PCR, and immune function assessment, is crucial for accurate diagnosis and timely intervention. Careful monitoring for opportunistic infections and prompt treatment are essential for optimizing outcomes in patients receiving immunomodulatory therapies like epcoritamab.
The patient’s successful recovery highlights the potential for effective management of complex infections in this vulnerable population, but also emphasizes the need for a proactive and comprehensive approach to infection control.
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