Mycophenolate-mofetil/prednisolone/tacrolimus

Abstract

Mycophenolate-mofetil/prednisolone/tacrolimus COVID-19 and methicillin-resistant Staphylococcus aureus infection: 6 case reportsA case series described, 6 men aged 56-32 years, who developed COVID-19 and/or methicillin-resistant Staphylococcus aureus infection during immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and prednisolone [not all routes and dosages stated; durations of treatments to reactions onsets not stated].Case 1: A 49-year-old man, who underwent a renal transplant in 2020, with history of insulin-dependent type-2 diabetes mellitus had been receiving immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and prednisolone 10mg. However, he presented to the hospital with dyspnoea and fever and was subsequently admitted. Various laboratory tests were performed while RT-PCR tested positive for COVID-19, which was attributed to immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and prednisolone. Thus, mycophenolate mofetil dose was reduced and prednisolone dose was increased to 15mg. His other medications included cotrimoxazole, aspirin/atorvastatin, silodosin, domperidone/rabeprazole, metoprolol, cilnidipine and insulin. On day 10, the RAT detection turned negative and he did not experience any other complaints. Hence mycophenolate-mofetil dose was increased, tacrolimus dose was adjusted based on its level and prednisolone dose was tapered to 10mg daily. He was symptomatically improved and discharged on day 12.Case 2: A 50-year-old man, who underwent a renal transplant in 2017, with history of type-2 diabetes mellitus and hypertension presented to the hospital with headache and fever and was subsequently admitted. He had been receiving immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and prednisolone. Various laboratory tests were performed. He was diagnosed with COVID-19, that was attributed to immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and prednisolone. Thus, mycophenolate-mofetil was discontinued while tacrolimus and prednisolone were continued. Further management included off-label azithromycin 500mg daily for COVID-19, calcium/colecalciferol [calcium-vitamin D3], zinc-acetate and heparin. His chest X-ray revealed bilateral pulmonary infiltration. Later, oxygen saturation improved to 95% with 4L oxygen from 86%. On day 11, he tested negative for COVID-19 and transferred to ward on day 12.Case 3: A 56-years-old man, who underwent a renal transplant in 2010, with history of type-2 diabetes mellitus and diabetic ketoacidosis since 20 years was shifted to the hospital on day 10, with complaints of cough, fever and dyspnoea. He had been receiving immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and oral prednisolone. Various laboratory tests were performed. RT-PCR from throat swab turned positive for COVID-19 on 16 October 2020, which was attributed to immunosuppressant drug therapy with tacrolimus, mycophenolate-mofetil and prednisolone. Thus, mycophenolate-mofetil and tacrolimus...