Case of "relapsing" COVID-19 in a kidney transplant recipient

Nephrology (Carlton). 2020 Dec;25(12):933-936. doi: 10.1111/nep.13786. Epub 2020 Sep 28.

Abstract

Clinical outcomes of COVID-19 vary considerably between patients. Little was known about the clinical course and optimal management of immunosuppressed patients infected with SARS-CoV-2. We report a kidney transplant recipient with COVID-19 who presented with pneumonitis and acute kidney injury (AKI). She improved after reduction of immunosuppressive treatment and had two consecutive negative reverse transcription polymerase chain reaction (RT-PCR) tests. Her respiratory tract samples turned positive again afterwards, and she was treated with lopinavir-ritonavir. She had satisfactory virological and clinical response after a prolonged disease course. This case illustrates the risk of relapse or persisting shedding of SARS-CoV-2 in immunosuppressed patients, the important role of viral load monitoring in management, the challenges in balancing the risks of COVID-19 progression and transplant rejection, and the pharmacokinetic interaction between immunosuppressive and antiviral medications.

Keywords: COVID-19; SARS-CoV-2; acute kidney injury; kidney transplantation; lopinavir-ritonavir.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19 / complications*
  • COVID-19 / immunology
  • COVID-19 Drug Treatment
  • Female
  • Humans
  • Kidney Transplantation*
  • SARS-CoV-2*
  • Viral Load