ABSTRACT
Introduction: Age and co-morbidity (including immunosuppression (IS)) are risk factors for severe coronavirus disease 2019 (COVID-19). Due to exposure to heavy IS, intestinal transplant (ITx) recipients may be at particular high risk for severe COVID-19. COVID-19 and its potential gastroenterological manifestations have not been reported after isolated ITx. Case Description: A 41-year-old female ITx recipient was hospitalized because of dehydration and electrolyte disturbances during the second European COVID-19 wave in November 2020. One year earlier, she had undergone an intestinal re-transplantation for chronic allograft enteropathy, 14 years after first ITx for chronic intestinal pseudo-obstruction. IS consisted of Tacrolimus, Azathioprine, and low-dose corticosteroids. On admission, her COVID-19 PCR was negative. Six days after admission, she tested positive on a screening COVID-19 nasopharyngeal PCR swab. At that time, she was asymptomatic and had normal inflammatory markers and a normal chest X-ray. Azathioprine was temporarily halted, and Tacrolimus slightly raised. Prophylactic low-molecular weight heparin (LMWH) was administered because of elevated D-dimers. One week after the positive test, she developed anosmia, mild dyspnea and a mild increase in CRP (25mg/L) was seen. Remdesivir was started at 200mg and continued at 100mg/day for 5 days. She presented a high stomal output 2 days in a row. An ileoscopy and biopsy showed no signs of infection or rejection. She was discharged after 4 weeks and remains in good health since then. Discussion: Despite presenting a mild form of COVID-19 infection, we preventively treated our ITx patient with LMWH and Remdesivir. Like for other solid organ Tx, azathioprine was temporarily halted/reduced. A transient increase in stomal output was observed but without proven rejection or infection. Conclusion: This is a first report of COVID-19 after isolated ITx. The disease was mild and the treatment similar to other organ transplant recipients. Registry data are needed to determine the real incidence and severity of COVD-19 after ITx and its potential gastrointestinal manifestations.