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This case report describes a 70-year-old Hispanic male with stage IIA MCC of the upper back which rapidly progressed during hospitalization for severe COVID-19 infection requiring ventilatory support. After resolution of his severe acute illness, he received one dose of anti-PD-1 therapy and single-fraction radiotherapy to his primary lesion for local control. His tumor then underwent a rapid regression and he completed 17 cycles of immunotherapy with a complete clinical and radiologic response sustained more than 4 years. This case illustrates a possible synergistic effect of radiation therapy and immune checkpoint inhibition after rebounding immune-system hyperactivation from infection with COVID-19.<\/jats:p>","DOI":"10.1177\/00031348261465398","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:32:21Z","timestamp":1782984741000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Complete Response of Merkel Cell Carcinoma to Immunotherapy and Single-Fraction Radiotherapy Following Severe COVID-19 Infection: A Case Report and Review of Immune Mechanism"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2649-4753","authenticated-orcid":false,"given":"Aubrey C.","family":"Swilling","sequence":"first","affiliation":[{"name":"University of Kansas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Caraway","sequence":"additional","affiliation":[{"name":"University of Kansas Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Thomas M.","family":"Irwin","sequence":"additional","affiliation":[{"name":"University of Kansas Cancer Center"},{"name":"Research Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor J.","family":"McCracken","sequence":"additional","affiliation":[{"name":"University of Kansas Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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