Allograft infiltration and meningoencephalitis by SARS-CoV-2 in a pancreas-kidney transplant recipient.

Westhoff, Timm H; Seibert, Felix S; Bauer, Frederic; Stervbo, Ulrik; Anft, Moritz; Doevelaar, Adrian A N; Rohn, Benjamin J; Winnekendonk, Guido; Dittmer, Ulf; Schenker, Peter; Vonbrunn, Eva; Amann, Kerstin; Viebahn, Richard; Babel, Nina

SARS-CoV-2 preferentially affects epithelia of the upper and lower respiratory tract. Thus, impairment of kidney function has been primarily attributed to secondary effects like cytokine release or fluid balance disturbances so far. We provide evidence that SARS-CoV-2 can directly infiltrate a kidney allograft. A 69-year old male, who underwent pancreas-kidney transplantation 13 years ago presented to our hospital with COVID-19 pneumonia and impaired pancreas and kidney allograft function. Kidney biopsy was performed showing tubular damage and an interstitial mononuclear cell infiltrate. RT-PCR from the biopsy specimen was positive for SARS-CoV-2. In-situ hybridization revealed SARS-CoV-2 RNA in tubular cells and the interstitium. Subsequently, he suffered from two convulsive seizures. Magnetic resonance tomography suggested meningoencephalitis, which was confirmed by SARS-CoV-2 RNA transcripts in the cerebrospinal fluid. The patient suffered from COVID-19 pneumonia, meningoencephalitis and nephritis. SARS-CoV-2 binds to its target cells through angiotensin-converting enzyme 2, which is expressed in a broad variety of tissues including the lung, brain, and kidney. SARS-CoV-2 thereby shares features with other human coronaviruses including SARS-CoV that were identified as pathogens beyond the respiratory tract as well. The present case should provide awareness that extrapulmonary symptoms in COVID-19 may be attributable to viral infiltration of diverse organs.