Case of “relapsing” COVID‐19 in a kidney transplant recipient

Clinical outcomes of COVID‐19 vary considerably between patients. Little was known about the clinical course and optimal management of immunosuppressed patients infected with SARS‐CoV‐2. We report a kidney transplant recipient with COVID‐19 who presented with pneumonitis and acute kidney injury (AKI...

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Published inNephrology Vol. 25; no. 12; pp. 933 - 936
Main Authors MA, Becky Mingyao, Hung, Ivan Fan Ngai, Chan, Gary Chi Wang, Tam, Anthony Raymond, Chan, Samuel Shung Kay, Wong, Bonnie Chun Kwan, Fukuda, Kenichiro, Ohno, Takanori, Yuen, Kwok Yung, Chan, Tak Mao
Format Journal Article Web Resource
LanguageEnglish
Published Melbourne John Wiley & Sons Australia, Ltd 01.12.2020
John Wiley & Sons, Inc
Wiley Subscription Services, Inc
Subjects
acute kidney injury
Adult
Brief Communication
Brief Communications
COVID-19
COVID-19 - complications
COVID-19 - drug therapy
COVID-19 - immunology
Female
Graft rejection
Humans
Kidney Transplantation
Kidney transplants
Lopinavir
lopinavir‐ritonavir
Patients
Pharmacokinetics
Pneumonitis
Polymerase chain reaction
Respiratory tract
Reverse transcription
Ritonavir
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Viral Load
COVID-19
SARS-CoV-2
acute kidney injury
lopinavir-ritonavir
kidney transplantation
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Summary:Clinical outcomes of COVID‐19 vary considerably between patients. Little was known about the clinical course and optimal management of immunosuppressed patients infected with SARS‐CoV‐2. We report a kidney transplant recipient with COVID‐19 who presented with pneumonitis and acute kidney injury (AKI). She improved after reduction of immunosuppressive treatment and had two consecutive negative reverse transcription polymerase chain reaction (RT‐PCR) tests. Her respiratory tract samples turned positive again afterwards, and she was treated with lopinavir‐ritonavir. She had satisfactory virological and clinical response after a prolonged disease course. This case illustrates the risk of relapse or persisting shedding of SARS‐CoV‐2 in immunosuppressed patients, the important role of viral load monitoring in management, the challenges in balancing the risks of COVID‐19 progression and transplant rejection, and the pharmacokinetic interaction between immunosuppressive and antiviral medications.
Bibliography:MA Becky Mingyao and Hung Ivan Fan Ngai contributed equally to this work.
ObjectType-Case Study-2
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ObjectType-Feature-4
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ObjectType-Report-1
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ISSN:1320-5358
1440-1797
DOI:10.1111/nep.13786