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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
A 53-year-old man developed thrombotic microangiopathy following treatment with tacrolimus, and COVID-19 pneumonia following treatment with mycophenolate mofetil, prednisolone and belatacept [not all routes, dosages, times to reactions onsets and outcomes stated].
The man had a history of end-stage renal disease secondary to polycystic kidney disease. He had undergone kidney transplant. Post-transplant, he had been receiving treatment with tacrolimus. However, he had developed tacrolimus induced thrombotic microangiopathy. Therefore, he was started on treatment with mycophenolate mofetil 250mg twice daily, prednisolone 5 mg/day and monthly IV belatacept infusions 5 mg/kg for the last 8 years. His received his last dose of belatacept on 11 March 2020. After six days of the last dose (17 March 2020), he developed shortness of breath and cough. Therefore, he was hospitalised on 12 April 2020 in the United Kingdom. His oxygen saturation was found to be 94% on 60% oxygen.
The man's treatment with belatacept and mycophenolate mofetil withheld. However, prednisolone was increased to 20 mg/day. He found positive for COVID-19 and chest X-ray suggested COVID-19 pneumonia. His clinical condition deteriorated. On 15 April 2020, he was intubated in the ICU for 4 days. His clinical condition complicated to a superadded bacterial pneumonia and urinary tract infection, which required unspecified antibiotics, and acute kidney injury. His acute kidney injury was resolving. He was shifted from ICU to the ward.
The man was restarted on mycophenolate mofetil on 19 April 2020. He turned negative for Covid-19. Subsequently, he was discharged. Laboratory investigation showed increased WBC, neutrophil count, C-reactive protein, creatinine and ferritin. On 7 May 2020, belatacept infusion was restarted.
Reference
- Ahmad SH, et al. Belatacept, kidney transplantation and COVID-19: Successful management of the first reported case within the United Kingdom. Clinical Transplantation 34: No. 9, 30 Jun 2020. Available from: URL: 10.1111/ctr.14026 [DOI] [PMC free article] [PubMed]