Tatapudi Ravi Raju, Kopparti Venkateswara Rao, Poosapati Anusha, Metta Srinivas, Palli Vedita, Vedulla Balakrishna
Apollo Hospitals, Health City, Visakhapatnam, India.
GITAM Institute of Medical Sciences and Research, Visakhapatnam, India.
Case Rep Nephrol Dial. 2021 Dec 7;11(3):367-373. doi: 10.1159/000520558. eCollection 2021 Sep-Dec.
COVID-19 pandemic affected millions of people across India. COVID-19 cases are fewer in children with less severity and better outcomes than in adults. However, a small proportion develop severe illness and succumb to the disease. Clinical manifestations and optimal management of COVID-19 in immunocompromised children are not clearly known. Remdesivir was shown to be efficient in reducing the recovery time in COVID-19 patients requiring supplemental oxygen. Remdesivir is approved for use in children with severe COVID-19, but there are no guidelines in patients with risk factors like recent solid organ transplantation. We report a case of a 10-year-old kidney transplant recipient (KTR) infected with severe acute respiratory syndrome corona virus-2, 2.5 months after the transplantation. Unlike most children, he presented with high fever, cough, and vomiting. His inflammatory markers were elevated. In this case report, we discussed management and clinical outcomes of this patient. In view of recent kidney transplantation and the severity of infection with emergent oxygen requirement, we gave him remdesivir. We continued prednisolone and tacrolimus and stopped mycophenolate. He recovered completely in 7 days. We feel that severely immunosuppressed KTR children with COVID-19 will benefit with remdesivir administration. Monitoring tacrolimus trough levels is essential for maintaining adequate immunosuppression.
新冠疫情影响了印度数百万民众。与成年人相比，儿童感染新冠病毒后的病例数较少，病情较轻，预后较好。然而，仍有一小部分儿童会发展为重症并死于该疾病。免疫功能低下儿童新冠病毒感染的临床表现及最佳治疗方案尚不清楚。瑞德西韦已被证明可有效缩短需要补充氧气的新冠患者的康复时间。瑞德西韦已获批用于重症新冠儿童，但对于近期接受实体器官移植等有风险因素的患者尚无相关指南。我们报告了一例10岁肾移植受者（KTR）在移植后2.5个月感染严重急性呼吸综合征冠状病毒2的病例。与大多数儿童不同，他出现了高烧、咳嗽和呕吐症状。他的炎症指标升高。在本病例报告中，我们讨论了该患者的治疗及临床结果。鉴于其近期进行了肾移植且感染严重并急需氧气，我们给予了他瑞德西韦治疗。我们继续使用泼尼松龙和他克莫司，并停用了霉酚酸酯。他在7天内完全康复。我们认为，感染新冠病毒的严重免疫抑制KTR儿童使用瑞德西韦治疗会受益。监测他克莫司血药谷浓度对于维持足够的免疫抑制至关重要。
