Clinical Presentation and Management of Coronavirus Disease 2019 in Renal Allograft Recipients: A Case Series

Abstract

A 49-year-old male who is a RT recipient since 2020, came with dyspnea and fever is a known case of insulin-dependent T2DM. The patient was on immunosuppression with tacrolimus, mycophenolate mofetil and prednisolone and RT-PCR tested positive. In view of COVID-19 infection mycophenolate mofetil dose was reduced and prednisolone dose (10 mg) was increased to 15 mg, other medications include cotrimoxazole, aspirin-atorvastatin, silodosin, rabeprazole-domperidone, metoprolol, cilnidipine and insulin. On day 10, the rapid antigen test detection turned negative and the patient did not experience any other complaints. Hence mycophenolate mofetil dose was increased, tacrolimus dose was adjusted based on tac level and prednisolone dose was tapered to 10 mg OD. The patient was symptomatically improved and discharged on day 12. Case 2A 50-year-old male who had live donor RT on 2017 with history of T2DM and HTN, presented to hospital with headache and fever. His treatment included tacrolimus, mycophenolate mofetil and prednisolone. He was diagnosed with COVID-19 infection on October 27. Mycophenolate mofetil was stopped and the rest continued. Further management included azithromycin 500 mg OD, calcium-vitamin D3 500 mg BD, zinc acetate 50 mg OD and heparin 5000 IU. His chest X-ray detected bilateral pulmonary infiltration. Oxygen saturation improved to 95% with 4 litres oxygen from 86%. On day 11, he tested negative for SARS-COV-2 and transferred to ward on day 12. Case 3A 56 years old male RT recipient (2010) with the history of T2DM and diabetic ketoacidosis since 20 years was shifted to our hospital on day 10