Threatening drug-drug interaction in a kidney transplant patient with coronavirus disease 2019 (COVID-19).

Abstract

During the novel coronavirus pandemic, organ transplant recipients represent a frail susceptible category due to long-term immunosuppressive therapy. For this reason, clinical manifestations may differ from general population and different treatment approaches may be needed. We present the case of a 36-year-old kidney-transplanted woman affected by Senior-Loken syndrome diagnosed with COVID-19 pneumonia after a contact with her positive mother. Initial symptoms were fatigue, dry cough, and coryza; she never had fever nor oxygen supplementation. Hydroxychloroquine and lopinavir/ritonavir were started, and the antiviral drug was replaced with darunavir/cobicistat after 2 days for diarrhea. Immunosuppressant levels were closely monitored, and we observed very high tacrolimus trough levels despite initial dose reduction. The patient was left with steroid therapy alone. The peculiarity of clinical presentation and the management difficulties represent the flagship of our case report. We stress the need for guidelines in transplant recipients with COVID-19 infection with particular regard to the management of therapy.

• Authors: Marilù Bartiromo, Beatrice Borchi, Annarita Botta, Alfredo Bagalà, Gianmarco Lugli, Marta Tilli, Annalisa Cavallo, Brunilda Xhaferi, Roberta Cutruzzulà, Augusto Vaglio, Silvia Bresci, Aida Larti, Alessandro Bartoloni, Calogero Cirami
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 22 Issue 4 Pg. e13286 (Aug 2020) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 32279418 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2020 Wiley Periodicals LLC.

Chemical References

• Antiviral Agents
• Cytochrome P-450 CYP3A Inhibitors
• Drug Combinations
• Enzyme Inhibitors
• Glucocorticoids
• Immunosuppressive Agents
• Interleukin-1beta
• Interleukin-6
• Interleukin-8
• lopinavir-ritonavir drug combination
• Interleukin-10
• Lopinavir
• Hydroxychloroquine
• C-Reactive Protein
• Cobicistat
• Ritonavir
• Tacrolimus
• Methylprednisolone
• Darunavir

Topics

• Adult
• Antiviral Agents (adverse effects, therapeutic use)
• Betacoronavirus
• C-Reactive Protein (immunology)
• COVID-19
• Ciliopathies (complications)
• Cobicistat (therapeutic use)
• Common Cold (etiology, physiopathology)
• Coronavirus Infections (complications, drug therapy, immunology, physiopathology)
• Cough (etiology, physiopathology)
• Cytochrome P-450 CYP3A Inhibitors (adverse effects)
• Darunavir (therapeutic use)
• Deprescriptions
• Drug Combinations
• Drug Interactions
• Enzyme Inhibitors (therapeutic use)
• Fatigue (etiology, physiopathology)
• Female
• Glucocorticoids (therapeutic use)
• Graft Rejection (prevention & control)
• Humans
• Hydroxychloroquine (therapeutic use)
• Immunocompromised Host (immunology)
• Immunosuppressive Agents (adverse effects)
• Interleukin-10 (immunology)
• Interleukin-1beta (immunology)
• Interleukin-6 (immunology)
• Interleukin-8 (immunology)
• Kidney Diseases, Cystic (complications)
• Kidney Failure, Chronic (etiology, surgery)
• Kidney Transplantation
• Leber Congenital Amaurosis (complications)
• Lopinavir (adverse effects)
• Methylprednisolone (therapeutic use)
• Optic Atrophies, Hereditary (complications)
• Pandemics
• Pneumonia, Viral (complications, drug therapy, immunology, physiopathology)
• Ritonavir (adverse effects)
• SARS-CoV-2
• Severity of Illness Index
• Tacrolimus (adverse effects)
• COVID-19 Drug Treatment