Foster Allison, Khan Zohaib, Siddiqui Aisha, Singh Sukhdev, Atere Muhammed, Nfonoyim Jay M
College of Medicine, American University of Antigua, New York, NY, USA.
Richmond University Medical Center, Staten Island, NY, USA.
SAGE Open Med Case Rep. 2020 Oct 15;8:2050313X20965423. doi: 10.1177/2050313X20965423. eCollection 2020.
The SARS-Cov-2/COVID-19 pandemic in early 2020 has had a devastating impact on health systems around the world. While viral pneumonia remains the most common complication, reports are surfacing of cases with neurological, cardiac, and renal involvement. Even less is known about the implications in special high-risk populations. In this report, we discuss a unique case of an HIV-positive patient in New York City who presented with a 2-week history of worsening fatigue, cough, dyspnea, and myalgias and was found to have COVID-19 pneumonia and acute kidney injury. He was managed for severe uremic metabolic acidosis and electrolyte abnormalities with emergent hemodialysis and supportive therapy with subsequent improvement. Direct involvement of SARS-CoV-2 and pneumonia-induced rhabdomyolysis were identified as the precipitating factors of his acute kidney injury. The pathophysiologic mechanisms of acute kidney injury, SARS-CoV-2 renal tropism, and the impact of highly active antiretroviral therapy on COVID-19 pneumonia are discussed. We highlight the importance of clinician awareness of this potentially fatal complication of COVID-19 pneumonia, particularly in the HIV-positive population as early recognition and management can have favorable outcomes.
2020年初的严重急性呼吸综合征冠状病毒2型/冠状病毒病（SARS-CoV-2/COVID-19）大流行对全球卫生系统造成了毁灭性影响。虽然病毒性肺炎仍然是最常见的并发症，但有关神经系统、心脏和肾脏受累病例的报道也不断出现。对于特殊高危人群中的影响了解更少。在本报告中，我们讨论了纽约市一名HIV阳性患者的独特病例，该患者有2周的疲劳、咳嗽、呼吸困难和肌痛加重病史，被发现患有COVID-19肺炎和急性肾损伤。他接受了紧急血液透析和支持治疗以处理严重的尿毒症代谢性酸中毒和电解质异常，随后病情有所改善。严重急性呼吸综合征冠状病毒2型的直接累及和肺炎诱导的横纹肌溶解被确定为其急性肾损伤的诱发因素。我们讨论了急性肾损伤的病理生理机制、严重急性呼吸综合征冠状病毒2型的肾脏嗜性以及高效抗逆转录病毒治疗对COVID-19肺炎的影响。我们强调临床医生认识到COVID-19肺炎这种潜在致命并发症的重要性，特别是在HIV阳性人群中，因为早期识别和处理可能会有良好的结果。
