Case Report: Successful Response to Intravenous Immunoglobulin and Steroid Pulses in a Renal Transplant Recipient With Severe Covid-19 Disease and Associated Acute Allograft Failure
Copyright policy )Case Report: Successful Response to Intravenous Immunoglobulin and Steroid Pulses in a Renal Transplant Recipient With Severe Covid-19 Disease and Associated Acute Allograft Failure
The impact of Covid-19 pneumonia caused by SARS-CoV-2 on transplanted populations under chronic immunosuppression seems to be greater than in normal population. Clinical management of the disease, particularly in those patients worsening after a cytokine storm, with or without allograft impairment and using available therapeutic approaches in the absence of specific drugs to fight against the virus, involves a major challenge for physicians. We herein provide evidence of the usefulness of high-dose intravenous immunoglobulin (IVIG) combined with steroid pulses to successfully treat a case of Covid-19 pneumonia in a single-kidney transplanted patient with mechanical ventilation and hemodialysis requirements in the setting of a cytokine storm. A rapid decrease in the serum level of inflammatory cytokines, particularly IL-6, IL-8, TNF-α, MCP-1 and IL-10, as well as of acute-phase reactants such as ferritin, D-dimer and C-reactive protein was observed after the IVIG infusion and methylprednisolone bolus administration with a parallel clinical improvement and progressive allograft function recovery, allowing the patient’s final discharge 40 days after the treatment onset. The immunomodulatory effect of IVIG together with the anti-inflammatory and immunosuppressive potential of steroids could be an alternative strategy to treat severe cases of Covid-19 pneumonia associated with an uncontrolled inflammatory response in transplanted populations.
- University of Córdoba Spain
- The Ohio State University United States
- Central Drug Research Institute India
- Hospital Universitario Reina Sofía Spain
- THE OHIO STATE UNIVERSITY United States
Graft Rejection, Male, Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Disease Progression, Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienetriols::Prednisolone::Methylprednisolone, Anti-Inflammatory Agents, Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans, Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Acute Disease, Medical Subject Headings::Anatomy::Body Regions::Transplants::Allografts, intravenous immunoglobulin, Trasplante de riñón, Medical Subject Headings::Phenomena and Processes::Biological Phenomena::Recovery of Function, Diálisis renal, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-6, Proteína C-reactiva, Immunoglobulins, Intravenous, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Respiratory Therapy::Respiration, Artificial, Middle Aged, Medical Subject Headings::Check Tags::Male, cytokine storm, Esteroides, Acute Disease, Ferritinas, Disease Progression, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Transplantation::Transplantation, Homologous, Steroids, Inmunoglobulinas intravenosas, Covid-19, Immunosuppressive Agents, steroids, Aloinjertos, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-10, Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Personnel::Physicians, Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive Agents, Immunology, kidney transplantation, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Hospitalization::Patient Discharge, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Albumins::C-Reactive Protein, Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections, Renal Dialysis, Medical Subject Headings::Persons::Persons::Age Groups::Adult::Middle Aged, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Kidney Transplantation, Humans, Transplantation, Homologous, Medical Subject Headings::Anatomy::Urogenital System::Urinary Tract::Kidney, Metilprednisolona, Síndrome de liberación de citoquinas, Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids, SARS-CoV-2, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Renal Dialysis, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-8, COVID-19, Medical Subject Headings::Phenomena and Processes::Immune System Phenomena::Immune System Processes::Transplantation Immunology::Host vs Graft Reaction::Graft Rejection, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Globulins::Serum Globulins::Immunoglobulins::Antibodies::Immunoglobulins, Intravenous, RC581-607, Inmunosupresores, Kidney Transplantation, Respiration, Artificial, Terapia de inmunosupresión, Transplant Recipients, COVID-19 Drug Treatment, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Carrier Proteins::Iron-Binding Proteins::Ferritins, Medical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Renal Insufficiency, Chronic::Kidney Failure, Chronic, Kidney Failure, Chronic, Immunologic diseases. Allergy, Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Inflammatory Agents
Graft Rejection, Male, Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Disease Progression, Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids::Pregnanes::Pregnadienes::Pregnadienetriols::Prednisolone::Methylprednisolone, Anti-Inflammatory Agents, Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans, Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Acute Disease, Medical Subject Headings::Anatomy::Body Regions::Transplants::Allografts, intravenous immunoglobulin, Trasplante de riñón, Medical Subject Headings::Phenomena and Processes::Biological Phenomena::Recovery of Function, Diálisis renal, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-6, Proteína C-reactiva, Immunoglobulins, Intravenous, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Respiratory Therapy::Respiration, Artificial, Middle Aged, Medical Subject Headings::Check Tags::Male, cytokine storm, Esteroides, Acute Disease, Ferritinas, Disease Progression, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Transplantation::Transplantation, Homologous, Steroids, Inmunoglobulinas intravenosas, Covid-19, Immunosuppressive Agents, steroids, Aloinjertos, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-10, Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Personnel::Physicians, Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Immunologic Factors::Immunosuppressive Agents, Immunology, kidney transplantation, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Hospitalization::Patient Discharge, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Albumins::C-Reactive Protein, Medical Subject Headings::Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections, Renal Dialysis, Medical Subject Headings::Persons::Persons::Age Groups::Adult::Middle Aged, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Kidney Transplantation, Humans, Transplantation, Homologous, Medical Subject Headings::Anatomy::Urogenital System::Urinary Tract::Kidney, Metilprednisolona, Síndrome de liberación de citoquinas, Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids, SARS-CoV-2, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Renal Dialysis, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Interleukins::Interleukin-8, COVID-19, Medical Subject Headings::Phenomena and Processes::Immune System Phenomena::Immune System Processes::Transplantation Immunology::Host vs Graft Reaction::Graft Rejection, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Globulins::Serum Globulins::Immunoglobulins::Antibodies::Immunoglobulins, Intravenous, RC581-607, Inmunosupresores, Kidney Transplantation, Respiration, Artificial, Terapia de inmunosupresión, Transplant Recipients, COVID-19 Drug Treatment, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Carrier Proteins::Iron-Binding Proteins::Ferritins, Medical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Renal Insufficiency, Chronic::Kidney Failure, Chronic, Kidney Failure, Chronic, Immunologic diseases. Allergy, Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Inflammatory Agents
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