Fatal SARS-CoV-2 infection in a renal transplant recipient
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CASE REPORT
Fatal SARS‑CoV‑2 infection in a renal transplant recipient Ahmet Burak Dirim1 · Erol Demir1 · Ali Riza Ucar1 · Nurana Garayeva1 · Seda Safak1 · Ozgur Akin Oto1 · Halil Yazici1 · Alpay Medet Alibeyoglu2 · Gunseli Orhun3 · Arif Atahan Cagatay4 · Aydin Turkmen1 Received: 13 May 2020 / Accepted: 10 June 2020 © Japanese Society of Nephrology 2020
Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) caused a pandemic that first discovered in Wuhan, China. While 10% of the patients have asymptomatic infection, 15–20% have lung involvement, 5–10% have multiple organ failure, and macrophage activation syndrome. Chronic respiratory diseases, diabetes mellitus, hypertension, and cancer are risk factors for mortality. Prognosis or optimal treatment strategy for renal transplant recipients in SARS-CoV-2 infection is still unknown. Besides fatal cases, there were also milder case reports. In addition, COVID-19 treatment and the maintenance immunosuppression strategy is still under debate. Antiviral therapies and drug interactions are special topics for these patients. To the best of our knowledge, favipiravir and anti-cytokine treatments have not been previously reported in a kidney transplant recipient with SARS-CoV-2 infection before. We report a case of SARS-CoV-2 infection in a kidney transplant recipient with fatal outcomes. Keywords COVID-19 · Renal transplantation · Treatment
Introduction The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused a pandemic that first discovered in Wuhan, China. This virus enters the cell via the angiotensinconverting enzyme II in the lung, and the upper respiratory tract causes Coronavirus disease 2019 (COVID-19) infection. While 10% of the patients have asymptomatic infection, 15–20% have lung involvement, 5–10% have multiple organ failure, and macrophage activation syndrome [1–3]. Chronic respiratory diseases, diabetes mellitus, hypertension, and cancer are risk factors for mortality. The risk
* Ahmet Burak Dirim [email protected] 1
Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
2
Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
3
Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
4
Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
of infection increases in kidney transplant recipients due to immunosuppressive therapy, comorbidity, and residual chronic kidney disease [2]. However, prognosis or optimal treatment strategy for renal transplant recipients in SARSCoV-2 infection is still unknown. Besides fatal cases, there were also milder case reports. Additionally, COVID-19 treatment and the maintenance immunosuppression strategy is still under debate. Antiviral therapies and drug interactions are special topics for these patients. To the best o
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