Severe COVID-19 in a kidney transplant recipient with acquired hypogammaglobulinemia: A case report

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.