Immunosuppressant
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COVID-19 pneumonia: 2 case reports In a study, a 63-year-old woman (Case 1) and a 70-year-old man (Case 2) were described, who developed COVID-19 pneumonia during immunosuppressive treatment with ciclosporin, everolimus, mycophenolate mofetil or prednisone [not all dosages and routes stated; duration of treatments to reactions onsets not stated]. Case 1: The woman, who had undergone kidney transplant, received triple maintenance therapy with ciclosporin [cyclosporine], mycophenolate mofetil and prednisone. She reported exposure to a confirmed COVID-19 patient. On 18 March 2020, she was admitted with the onset of diarrhoea, dry cough, and difficulty breathing and fever. Fever and difficulty breathing had begun one day and seven days before admission, respectively. Mycophenolate mofetil was precautionarily suspended 2 days prior to admission. Physical examination was as follows: body temperature 37.5°C, normal BP and pulse rate, and blood oxygen saturation 96%. Relevant blood tests were as follows: lymphopenia, D-dimer 3900 ng/mL, C-reactive protein 7.85 mg/dL, procalcitonin 0.052 ng/mL, and ferritin 355 ng/mL. Arterial blood gas analysis showed hypoxaemia, with arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio of 314, and respiratory alkalosis. Chest CT was consistent with bilateral interstitial pneumonia. Nine days following the onset of the symptoms, SARS-CoV-2 was identified by real-time reverse transcriptionpolymerase chain reaction (RT-PCR) on nasopharyngeal swab. On the same day, ciclosporin was stopped and the corticosteroid therapy was increased to methylprednisolone 20 mg/day (maintenance dose prednisone 2.5 mg/d). Additionally, an antiviral therapy with oral darunavir/ritonavir 800/100mg per day was initiated. Hydroxychloroquine was contraindicated due to an elevated QT interval and it was not administered. Sodium enoxaparin was initiated. After 72 hours, her respiratory symptoms deteriorated, with tachypnoea, fever, and decreased oxygen saturation, requiring flow oxygen supplementation. Hyperglycaemia and hypertension required a temporary reduction of the steroid dose. Two weeks following the onset of symptoms, her condition improved, with gradual disappearance of fever and dry cough. Diarrhoea disappeared soon thereafter. After two consecutive negative SARS-CoV-2 nasopharyngeal swab tests, she was discharged. Ciclosporin was restarted on the same day along with oral prednisone. Gradually, corticosteroid were tapered to baseline levels. Kidney function remained stable during admission. Case 2: The man, who had undergone kidney transplant was receiving triple immunosuppressive maintenance therapy with mycophenolate mofetil, ciclosporin [cyclosporine] and prednisone. Afterwards, he was switched from mycophenolate mofetil to everolimus in 2014. On 18 March 2020, he was admitted due to low-grade fever and cough, which was persisting since 10 days. Physical examination was as follows: body temperature 37.8°C, normal BP and pulse rate, and a blood oxygen saturation of 97%. Re
