Invasive pulmonary aspergillosis associated with COVID-19 in a kidney transplant recipient

Transpl Infect Dis. 2021 Apr;23(2):e13501. doi: 10.1111/tid.13501. Epub 2020 Nov 29.

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might increase the risk of invasive pulmonary aspergillosis (IPA). Although several case reports and small series have been reported in the general population, scarce information is available regarding coronavirus disease 2019 (COVID-19)-associated IPA in the setting of solid organ transplantation. We describe a case of a kidney transplant recipient with severe COVID-19 that was subsequently diagnosed with probable IPA on the basis of the repeated isolation of Aspergillus fumigatus in sputum cultures, repeatedly increased serum (1 → 3)-β-d-glucan levels, and enlarging cavitary nodules in the CT scan. The evolution was favorable after initiation of isavuconazole and nebulized liposomal amphotericin B combination therapy and the withdrawal of immunosuppression.

Keywords: coronavirus disease 2019; invasive pulmonary aspergillosis; kidney transplantation.; severe acute respiratory syndrome coronavirus 2; solid organ transplantation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Kidney Injury
  • Administration, Inhalation
  • Amphotericin B / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antifungal Agents / therapeutic use*
  • Azithromycin / therapeutic use
  • COVID-19 / complications
  • COVID-19 / immunology
  • COVID-19 / therapy*
  • Ceftriaxone / therapeutic use
  • Deprescriptions
  • Female
  • Glucocorticoids / adverse effects
  • Graft Rejection / prevention & control
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Hyperoxaluria, Primary / complications
  • Hyperoxaluria, Primary / diagnosis
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunologic Factors / therapeutic use
  • Immunosuppressive Agents / adverse effects*
  • Invasive Pulmonary Aspergillosis / complications
  • Invasive Pulmonary Aspergillosis / diagnostic imaging
  • Invasive Pulmonary Aspergillosis / drug therapy*
  • Invasive Pulmonary Aspergillosis / immunology
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / pathology
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation*
  • Middle Aged
  • Mycophenolic Acid / adverse effects
  • Nitriles / therapeutic use
  • Oxygen Inhalation Therapy
  • Prednisone / adverse effects
  • Pyridines / therapeutic use
  • Renal Dialysis
  • SARS-CoV-2
  • Sputum
  • Tacrolimus / adverse effects
  • Tomography, X-Ray Computed
  • Triazoles / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Antibodies, Monoclonal, Humanized
  • Antifungal Agents
  • Glucocorticoids
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Immunosuppressive Agents
  • Nitriles
  • Pyridines
  • Triazoles
  • liposomal amphotericin B
  • Hydroxychloroquine
  • isavuconazole
  • Ceftriaxone
  • Amphotericin B
  • Azithromycin
  • Mycophenolic Acid
  • tocilizumab
  • Prednisone
  • Tacrolimus