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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 780-784. doi: 10.19723/j.issn.1671-167X.2020.04.033

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Severe acute respiratory syndrome coronavirus 2 infection in renal transplant recipients: A case report

Qiu-yu LI1,Qin CHENG1,Zhi-ling ZHAO2,Ni-ni DAI1,Lin ZENG3,Lan ZHU4,Wei GUO5,Chao LI2,Jun-hong WANG6,Shu LI6,Qing-gang GE2,Ning SHEN1,△()   

  1. 1. Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
    2. Department of Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
    4. Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
    5. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
    6. Department of Emergency, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-04-12 Online:2020-08-18 Published:2020-08-06
  • Contact: Ning SHEN E-mail:shenning1972@126.com
  • Supported by:
    National Natural Science Foundation of China(81900641);Fundamental Research Funds for the Central Universities: the Special Research Fund of PKU for Prevention and Control of COVID-19(BMU2020HKYZX011);National R&D Program of China(2020YFC0844500);National R&D Program of China(2020YFC0844900)

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Abstract:

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.

Key words: Corona virus disease 2019, Kidney transplantation, Immunosuppressive agents

CLC Number: 

  • R563.1

Figure 1

The chest computed tomography of the patient at the time of onset Non-enhanced chest computed tomography (CT) showed the multiple patches of ground-glass in the left lower lung."

Figure 2

Changes in the patient’s body temperature The body temperature was normal (36.0 ℃) at the time of admission, and the fever of remittent appeared from the next day. The body temperature fluctuated from 37.9 ℃ to 38.8 ℃. Since the 7th day of hospitalization, the body temperature dropped to normal and fluctuated at 35.8 ℃ to 36.7 ℃. D, day; am, ante meridiem; pm, post meridiem."

Figure 3

Changes in laboratory test results during the hospital stay of the patient The patient was in the chronic kidney disease (CKD) 3 stage at the time of admission, and on the 9th day of hospitalization, there was a progressive decrease in serum creatinine (Scr) with estimated glomerular filtration rate (eGFR) returning to 50 mL/(min·1.73 m2). After admission, leukocytes (WBC) fluctuated from 1.0×109/L to 8.0×109/L, and that of platelets (PLT) increased from 120×109/L to 220×109/L. Lymphocytes (LYM) decreased from 0.4×109/L to 0.2×109/L, and continued to rise to 1.5×109/L on the 7th day. Meanwhile, high sensitivity C-reactive protein (hs-CRP) decreased to normal after reaching a peak (35 mg/L) on the 5th day. D, day."

Figure 4

Changes in the chest computed tomography images during the hospital stay of the patient A, the chest computed tomography (CT) with axial planes showed the multiple mixed ground-glass opacities and linear opacities in the bilateral lung lobes; B, the chest CT with axial planes showed the improvement of pneumonia with decreased ground-glass opacities and linear opacities in the subpleural area, and partial consolidation was increased; C, the chest CT with axial planes showed the minimal absorption of both ground-glass opacities and linear opacities in the bilateral lung lobes, the overall was similar to B."

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