Pediatric liver transplantation and COVID-19: a case report
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CASE REPORT
Open Access
Pediatric liver transplantation and COVID19: a case report Hamed Nikoupour1, Kourosh Kazemi1, Peyman Arasteh1, Saba Ghazimoghadam1*, Hesameddin Eghlimi1, Naghi Dara2, Siavash Gholami1 and Saman Nikeghbalian1
Abstract Background: Immunosuppressed patients, including individuals with organ transplantation, have been among susceptible groups with regard to COVID-19, on the other hand pediatric patients more commonly undergo a mild clinical course after acquiring COVID-19. To the best of the authors knowledge, to this date very little data exists on COVID-19 in a pediatric patient with liver transplantation. Case presentation: We report a three year-old boy who had liver transplantation at 18 months old. He was admitted due to dyspnea with impression of acute respiratory distress syndrome and was then transferred to the intensive care unit. Chest X-ray at admission showed bilateral infiltration. Vancomycin, meropenem, azithromycin, voriconazole and co-trimoxazole were started from the first day of admission. On day 4 of admission, with suspicion of COVID-19, hydroxychloroquine, lopinavir/ritonavir and oseltamivir were added to the antibiotic regimen. PCR was positive for COVID-19. The patient developed multi-organ failure and died on day 6 of admission. Conclusions: For pediatric patients with organ transplantations, extreme caution should be taken, to limit and prevent their contact with COVID-19 during the outbreak, as these patients are highly susceptible to severe forms of the disease. Keywords: COVID-19, liver, Transplantation, Pediatric
Background Immunosuppression is the main risk factor for infections which is an important cause of mortality and morbidity after liver transplantation (LT) in children. Bacterial and fungal organisms are the most common causes of infection in the first month after LT. After this duration, community-acquired viruses are the most common infections associated with chronic graft dysfunction (especially after 6 months). Cytomegalovirus and Epstein-Barr virus are the leading viruses which cause infection after the first month of LT [1, 2]. Currently, an outbreak related to a novel Coronavirus known as COVID-19 has become an international * Correspondence: [email protected] 1 Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Full list of author information is available at the end of the article
concern. LT recipients are among the most vulnerable groups with increased risk of infection but to this date there has been no report of COVID-19 in a pediatric patient with liver transplantation. Here we report a case of a pediatric patient who had LT and acquired COVID-19.
Case presentation A 3 year old boy, was admitted due to dyspnea in February, 2020. He presented with weakness, malaise, anorexia, severe dry cough, tachypnea and respiratory distress from 4 days prior to his admission. In his past medical history the patient was premature and had liver cirrhosis due to biliary atresia. He underwent a living don
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