A case of late-onset organizing pneumonia following COVID-19 infection in a post-kidney transplant patient

Abstract

A 50-year-old man who had undergone a living-donor kidney transplant 12 years prior for chronic renal failure due to autosomal dominant polycystic kidney disease contracted coronavirus disease 19 (COVID-19). He had a positive antigen test, mild symptoms, sore throat, and fever of 37.9 ℃. The patient was treated with molnupiravir for 5 days, and the symptoms disappeared 5 days after onset. However, 10 days after onset, he developed a fever of approximately 37 ℃ and a non-productive cough; 27 days after onset, the patient was hospitalized for anorexia and a worsening respiratory condition. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test results on admission were negative, and no antiviral medications were administered against SARS-CoV-2. Computed tomography revealed extensive ground-glass opacities in both lung fields. The patient was treated with steroid pulse therapy, ceftriaxone, atovaquone, azithromycin, and respiratory management using a high-flow nasal cannula. The combined therapies were successful, and the patient was managed with a nasal oxygen cannula after 3 days. Oxygen administration was discontinued after 6 days of hospitalization, and the patient was discharged after 14 days. Based on the laboratory findings, bacterial, interstitial, and Pneumocystis pneumonia were unlikely. The success of the steroid pulse therapy suggested that respiratory failure was caused by pneumonia due to the immune response after COVID-19 infection.

Keywords: Kidney transplantation; Post-COVID-19; SARS-CoV-2.

Fig. 1

Clinical course on chest computed tomography a: On admission, ground-glass opacities are observed in both lung fields, with some infiltration shadows; b: Eighth day in the hospital, shadows in the lung fields are decreased; c: Thirty-sixth day in the hospital, the lung consolidation has disappeared

Fig. 2

Clinical course of C-reactive protein (CRP) and creatinine (Cre) levels. mPSL methylprednisolone, PSL prednisolone, Tac tacrolimus, MMF mycophenolate mofetil, AZM azithromycin, CTRX ceftriaxone, ATO atovaquone, COI cut-off index