Detected SARS-CoV-2 in Ascitic Fluid Followed by Cryptococcemia: a Case Report
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COVID-19
Detected SARS-CoV-2 in Ascitic Fluid Followed by Cryptococcemia: a Case Report Victor C. Passarelli 1 & Ana H. Perosa 1 & Luciano Kleber de Souza Luna 1 & Danielle D. Conte 1 & Oliver A. Nascimento 2 & Jaquelina Ota-Arakaki 2 & Nancy Bellei 1 Accepted: 2 October 2020 # Springer Nature Switzerland AG 2020
Abstract SARS coronavirus-2 (SARS-CoV-2) detection in different clinical specimens has raised important insights about its pathogenesis, but some details remain to be understood. In that respect, disrupt viral control seen in solid organ transplant patients on chronic immunosuppression can help unveil pathogenic mechanisms and characterize new coronavirus disease-19 (COVID-19) immunological and clinical aspects, as well as secondary complications. We herein report a case of SARS-CoV-2 detection in ascitic fluid from a kidney transplant patient with decompensated cirrhosis and COVID-19 and then discuss about immune, cellular, and virological aspects of such clinical presentation of the disease, which also included a disseminated infection, demonstrated by viral detection in his blood sample. We subsequently discuss about the fatal outcome caused by a secondary bloodstream infection by Cryptococcus neoformans. This unprecedented case report presents ascitic fluid as a novel specimen in which SARS-CoV-2 can be detected. Immune dysregulation and cumulative risk factors may lead to secondary infections by opportunistic agents, including Cryptococcus neoformans. Keywords Cryptococcus . Cirrhosis . COVID . Coinfection . Viremia . Kidney transplant
Introduction SARS coronavirus-2 (SARS-CoV-2) affects primarily upper and lower respiratory tract, but detection in different clinical specimens, including serum and stool, has raised important insights about its kinetics and pathogenesis [1]. In that respect, disruption in viral control seen in solid organ transplant patients on chronic immunosuppression [2] can help pathogenic mechanisms and characterize new coronavirus disease-19 (COVID-19) immunological and clinical aspects, as well as secondary complications.
This article is part of the Topical Collection on Covid-19 * Victor C. Passarelli [email protected] 1
Infectious Diseases Division, Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
2
Pulmonology Division, Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
We herein report an unprecedented case of SARS-CoV-2 detection in ascitic fluid from a kidney transplant patient with decompensated cirrhosis and COVID-19 and then discuss about immune, cellular, and virologic aspects of such clinical presentation of the disease, which also included a disseminated infection, demonstrated by viral detection in his blood sample. We then discuss about the fatal outcome caused by a secondary bloodstream infection by Cryptococcus neoformans.
Case Report A 75-year-old white male with a history of hypertension, and a kidney transplant from a deceased dono
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