A case of successful treatment of severe COVID-19 pneumonia with favipiravir and tocilizumab in post-kidney transplant recipient
A case of successful treatment of severe COVID-19 pneumonia with favipiravir and tocilizumab in post-kidney transplant recipient
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DOI：
10.1111/tid.13388
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发表时间：
2020-07-10
影响因子：
2.6
通讯作者：
Townamchai, Natavudh
中科院分区：
文献类型：
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作者：
Thammathiwat, Theerachai;Tungsanga, Somkanya;Townamchai, Natavudh
我们报告了一例泰国肾移植患者的COVID-19病例。一名58岁的肾移植后2年的接受者，维持免疫抑制他克莫司，霉酚酸酯（MMF），和泼尼松龙，出现急性腹泻，其次是发烧的第12天。发烧后第7天出现肺炎症状和全血细胞计数淋巴细胞减少症，X线检查发现双侧多灶性斑片状浸润。通过鼻拭子和粪便中的反向实时聚合酶链反应（PCR）证实了COVID-19感染。在初级医院入院的第一天开始使用地瑞那韦与利托那韦、羟氯喹、阿奇霉素和法匹拉韦。患者于入院第2天转入我院，停用他克莫司和MMF。住院第4-5天需要高流量鼻插管氧疗。在血清IL-6水平升高后给予托珠单抗。肺炎症状改善，从住院第10天起无需氧疗。他克莫司与抗病毒治疗之间的药物相互作用导致他克莫司浓度严重升高，支持治疗后可引起可逆性急性肾损伤（阿基）。
We report a case of COVID-19 in kidney transplant patient in Thailand. A 58-year-old 2 years post-kidney transplant recipient, with maintenance immunosuppression of tacrolimus, mycophenolate mofetil (MMF), and prednisolone, presented with acute diarrhea which followed by fever on day 12. Symptoms of pneumonia together with lymphopenia from complete blood count were developed on day 7 after onset of fever with the x-ray finding of bilateral multifocal patchy infiltration. COVID-19 infection has been confirmed by reverse real-time polymerase chain reaction (PCR) in nasal swab as well as found in stool. Darunavir together with ritonavir, hydroxychloroquine, azithromycin, and favipiravir was initiated on the first day of admission at primary hospital. Patient has been transferred to our hospital on day 2 of admission in which tacrolimus together with MMF was discontinued. High-flow nasal cannula oxygen therapy was required on days 4-5 of hospitalization. Tocilizumab was administered after rising of serum IL-6 level. Symptoms of pneumonia were improved in which no oxygen treatment required from day 10 of hospitalization. Drug interaction between tacrolimus and anti-viral treatment leads to severely high level of tacrolimus which caused reversible acute kidney injury (AKI) after supportive treatment.