Tacrolimus
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Tacrolimus Transient thrombotic microangiopathy: case report
A 28-year-old woman developed transient thrombotic microangiopathy during immunosuppressants therapy with tacrolimus. The woman presented due to malaise, rhinorrhoea, sore throat and sub-febrile fevers, which started 2 days following a tourist trip to England. Her medical history was significant for a lupus-like syndrome, for which she had received cyclophosphamide, mycophenolate mofetil and unspecified corticosteroids. Recently, she was diagnosed end-stage renal disease, because of chronic glomerulonephritis from the lupus-like syndrome, for which she had undergone a living-donor kidney transplantation 6 months prior to this presentation. For the kidney transplant, she started receiving immunosuppressants therapy comprising: anti-thymocyte globulin (as an induction therapy) and triple maintenance therapy, consisting oral tacrolimus [dosage not stated], mycophenolate mofetil and prednisone. In the early period following the kidney transplant, she developed a transient thrombotic microangiopathy, which was suspected to be induced by tacrolimus [duration of treatment to reaction onset not stated]. The woman responded well to only 2 courses of eculizumab treatment with no relapse. During the first clinical evaluation, only mild hyperaemia of the tonsils and pharyngeal mucosa were observed, and she was empirically treated with antibiotics. However, the next day she presented again with high fever. Swab test was performed for COVID-19, and considering a possibility of COVID-19, off-label therapy with oseltamivir was initiated. She was discharged from the emergency department on the same day, but with very strict instructions of home-isolation. Six days later, she was found to be positive for COVID-19. Although the symptoms were mild, she was hospitalised for further testing and close monitoring. No change in the respiratory functions or vital signs were noted during the 24-hour hospitalisation for monitoring. After 24 hours, she was discharged. Seven days following the discharge, her swab test for COVID-19 was found to be negative. Arpali E, et al. Case report: A kidney transplant patient with mild COVID-19. Transplant Infectious Disease 22: No. 4, Aug 2020. Available from: URL: http:// doi.org/10.1111/tid.13296
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Reactions 5 Sep 2020 No. 1820
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