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Case Report
Severe COVID-19 in a kidney transplant recipient with acquired hypogammaglobulinemia: A case report
1 Medical Student, Department of Clinical Medicine, University of Bergen, Bergen, Norway
2 Nephrologist and PhD candidate, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
3 Anesthesiologist and Professor, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Anesthesiology & Intensive Care Medicine, Haukeland University Hospital, Bergen, Norway
4 Nephrologist and PhD, Department of Transplantation Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
5 Nephrologist and Associate Professor, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
Address correspondence to:
Mariell Rivedal
Department of Clinical Medicine, University of Bergen, Jonas Lies vei 91B, Bergen, Vestland 5021,
Norway
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Article ID: 100070Z09MR2022
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Rivedal M, Haaskjold YL, Guttormsen AB, Midtvedt K, Knoop T. Severe COVID-19 in a kidney transplant recipient with acquired hypogammaglobulinemia: A case report. J Case Rep Images Med 2022;8(2):1–6.ABSTRACT
Introduction: Kidney transplant recipients have an increased risk of a severe clinical course and mortality due to coronavirus disease 2019 compared to that in the average population, and their treatment options are limited because reduced immunosuppression may lead to graft rejection. Herein, we describe a successful therapeutic regime in a kidney transplant recipient who suffered from coronavirus disease 2019-associated acute respiratory distress syndrome.
Case Report: In this case report, we describe the course and management of a kidney transplant recipient who had severely reduced graft function (estimated glomerular filtration rate: 10–14 mL/min/1.73 m2) and acquired hypogammaglobulinemia and was consequently hospitalized and treated for severe coronavirus disease 2019. She presented with gastrointestinal symptoms, followed by increasing dyspnea, which rapidly progressed to acute respiratory distress syndrome. During hospitalization, she was treated under a ventilator (prone positioning) and with convalescent plasma, dexamethasone, careful monitoring of immunosuppression, continuous venovenous hemofiltration, and venovenous extracorporeal membrane oxygenation. Owing to successful treatment, the patient was discharged from the hospital after 74 days in a good condition and with a well-functioning kidney graft.
Conclusion: Convalescent plasma, dexamethasone, monitoring of immunosuppression, continuous venovenous hemofiltration, and venovenous extracorporeal membrane oxygenation might be effective therapeutic options in kidney transplant recipients and other immunosuppressed patients with coronavirus disease 2019-associated acute respiratory distress syndrome.
Keywords: Acute respiratory distress syndrome, COVID-19, Immunosuppression therapy, Kidney transplant recipient
SUPPORTING INFORMATION
Author Contributions
Mariell Rivedal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yngvar Lunde Haaskjold - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Anne Berit Guttormsen - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Karsten Midtvedt - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Thomas Knoop - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Mariell Rivedal et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
