Antithymocyte globulin

Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In a study involving 10 patients (hospitalised or discharged between 01 March 2020 and 27 March 2020), three patients (one man and two women) aged 30.71−63.06 years were described, who developed coronavirus disease-2019 (COVID-19), Enterococcus infection or Klebsiella pneumonia following immunosuppression induction with antithymocyte globulin [not all times to reactions onsets not stated].

The patients, who underwent kidney transplantation, received immunosuppression induction with antithymocyte globulin [route and dosage not stated]. Concomitantly, the patients received various other drugs. In 1346−3366 days from the transplantion, the patients developed COVID-19. At hospitalisation, the presenting symptoms were cough, chills, nasal congestion and myalgias (1 patient), fever, chills, myalgias, cough and headache (1 patient) and fever, myalgias, headache and emesis (1 patient). In two of the three patients, chest X-ray showed relative radiation level and nodular opacities. CT findings showed patch opacity/multifocal in two of the three patients. Laboratory test results were as follows: WBC initial 3.78−9.1 K/µL, WBC nadir 2.38−4.02 K/µL, lymphocyte count 0.81−1.22 [unit not stated], ferritin 101−1664 ng/mL, CRP 3.44−17.97 mg/dL, initial creatinine 1.2−1.93 mg/dL and peak creatinine 1.2−1.9 mg/dL. Exposure of COVID-19 was community-acquired (2 patients) and healthcare-acquired (1 patient). Additionally, two of the three patients exhibited presence of Enterococcus infection in urine (1 patient) and Klebsiella pneumonia in urine (1 patient). Antithymocyte globulin treatment was associated with higher risk of infections.

The patients received off-label treatment with hydroxychloroquine and azithromycin for COVID-19. Two of the three patients received antimicrobial therapy with ceftriaxone. In addition, the patients required oxygen at room air. Subsequently, the patients were discharged [outcomes not stated].