Suspected pneumonia caused by COVID-19 after kidney transplantation: A Case Report

Kijima, Yu; Shimizu, Tomokazu; Kato, Shinya; Sekido, Eri; Kano, Kana; Toguchi, Makoto; Horiuchi, Toshihide; Nozaki, Taiji; Omoto, Kazuya; Inui, Masashi; Toma, Hiroshi; Iida, Shoichi; Takagi, Toshio

BACKGROUND: Coronavirus disease-2019 (COVID-19) infection may become more severe in those who have undergone kidney transplantation than in the general population. False-negative reverse transcription-polymerase chain reaction (RT-PCR) results have been reported for COVID-19 infection.Patients might carry infection even though RT-PCR results are negative. CASE REPORT: A 65-year-old man with a 19-year history of ABO-incompatible kidney transplantation presented with fever and arthralgia. Although the RT-PCR result was negative, a focal slit glass shadow in the left upper lobe on computed tomography (CT) suggested COVID-19 pneumonia. His symptoms did not improve until after 10 days and CT showed multiple slit-glass shadows in the bilateral lung fields. However, RT-PCR remained negative. The patient was admitted and mycophenolate mofetil was discontinued. Anticoagulants were administered on the 3(rd) day of hospitalization. Due to poor oxygenation, the patient was intubated in the intensive care unit on the 5th day, and sivelestat sodium was administered. The patient was extubated on the 12(th) day following improvement in oxygenation. There was no exacerbation, and CT showed improvements on the 51(st) day. CONCLUSIONS: We report a case of pneumonia with suspected COVID-19 infection 18 years after living-donor kidney transplantation. If COVID-19 is suspected, infection control and aggressive therapeutic interventions should be undertaken with the possibility of a positive result in mind.