ABSTRACT
A 28-year-old female who underwent an uneventful femtosecond laser enabled keratoplasty (FLEK) in her left eye presented with pain, redness, and blurring of vision in the operated eye two weeks after getting immunized with COVID-19 vector vaccine (ChAdOx1 nCoV19 Vaccine Recombinant COVISHIELD, AstraZeneca). Slit-lamp examination showed donor stromal edema with Descemet's membrane folds and Khodadoust line (KP's on endothelium) with anterior chamber cells and flare. The patient was diagnosed with acute corneal graft rejection and advised hourly topical steroids with cycloplegics and oral steroids. The patient responded to treatment and there was progressive reversal of graft rejection with the patient achieving best spectacle-corrected visual acuity (BSCVA) of 20/30 after five weeks of treatment. Our case highlights possible immune corneal graft rejection after COVID19 vaccination and the need to step up topical steroids before vaccination.
Subject(s)
COVID-19 , Corneal Diseases , Corneal Transplantation , Adult , COVID-19 Vaccines/adverse effects , ChAdOx1 nCoV-19 , Corneal Diseases/surgery , Corneal Transplantation/adverse effects , Endothelium , Female , Graft Rejection/diagnosis , Humans , Immunization , Postoperative Complications , Steroids , Vaccination , Visual AcuityABSTRACT
Kidney transplant recipients who develop coronavirus disease 2019 (COVID-19) are at increased risk of life-threatening illness, which often requires reducing immunosuppression despite the potential risk of causing an allograft rejection. Herein, we describe the clinical presentation and course of a kidney transplant recipient who acquired COVID-19 and was hospitalized with severe symptoms and hypoxemia. Upon admission, the patient was found to have elevated de novo donor-specific antibodies (DSA) yielding a positive cytotoxicity crossmatch and concurrent elevated plasma donor-derived cell-free DNA (dd-cfDNA) level, indicating a possible ongoing rejection despite improvement in his serum creatinine. Because of persistent positive COVID-19 tests and stable serum creatinine, a kidney allograft biopsy was initially deferred and his dd-cfDNA and DSA were monitored closely postdischarge. Three months later, because of persistent elevated dd-cfDNA and positive DSA, a kidney allograft biopsy was performed, which showed chronic active antibody-mediated rejection. Accordingly, the patient was treated with intravenous immunoglobulin and his maintenance immunosuppressive regimen was increased.
Subject(s)
COVID-19/diagnosis , Graft Rejection/prevention & control , Kidney Transplantation , Antibodies/blood , Antibodies/immunology , COVID-19/complications , COVID-19/virology , Cell-Free Nucleic Acids/blood , Creatinine/blood , Graft Rejection/diagnosis , HLA-DR7 Antigen/immunology , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/blood , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Oxygen Inhalation Therapy , SARS-CoV-2/isolation & purification , Tacrolimus/blood , Tacrolimus/therapeutic useABSTRACT
PURPOSE: To report a case of acute corneal endothelial graft rejection with the concurrent onset of coronavirus disease 2019 (COVID-19) symptoms. METHODS: Case report. RESULTS: A 31-year-old African American woman with a history of asthma, sleep apnea, obesity (body mass index of 40), and bilateral keratoconus was noted to have acute corneal endothelial graft rejection 3 months after uncomplicated penetrating keratoplasty of the left eye. The patient developed dysgeusia and subjective fever on the same day as ocular discomfort, and she was subsequently diagnosed with COVID-19 with only these 2 classic symptoms of the viral infection. CONCLUSIONS: Severe acute respiratory syndrome coronavirus 2 is known to cause conjunctivitis and has demonstrated transmissibility through ocular secretions. Acute immune and inflammatory dysregulations have been seen in cases of COVID-19 through various mechanisms. COVID-19 infection may potentially compromise ocular immune privilege contributing to acute corneal graft rejection.
Subject(s)
COVID-19/diagnosis , Endothelium, Corneal/pathology , Graft Rejection/diagnosis , Keratoconus/surgery , Keratoplasty, Penetrating , SARS-CoV-2 , Acute Disease , Adult , COVID-19/etiology , COVID-19 Testing , Dysgeusia/diagnosis , Female , Graft Rejection/etiology , Humans , Polymerase Chain Reaction , Reoperation , Visual Acuity/physiologySubject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Cell-Free Nucleic Acids/blood , Heart Transplantation , Postoperative Complications/diagnosis , SARS-CoV-2 , Tissue Donors , Adult , COVID-19/blood , COVID-19/genetics , Diagnosis, Differential , Gene Expression Profiling , Graft Rejection/blood , Graft Rejection/diagnosis , Humans , Male , Postoperative Complications/blood , Postoperative Complications/genetics , SARS-CoV-2/isolation & purificationABSTRACT
BACKGROUND: Kidney allograft biopsy is the gold standard for diagnosis of rejection. Under the current extraordinary circumstances of the coronavirus disease 2019 (COVID-19), in which social distancing is key to limiting the spread of the virus, the model used to provide care to transplant recipients has undergone a very rapid transformation. In the spirit of medical distancing, we have been using the donor-derived cell-free DNA (dd-cfDNA) test for screening for rejection. METHODS: This article describes our experience with this approach between March 15th and May 20th, 2020. RESULTS: This test was obtained for-cause in 23 patients and for monitoring in 9 patients. Normal results aided in forgoing biopsy in 63% of the patients for whom the test was obtained in the outpatient setting. The test is neither 100% sensitive nor specific for rejection; however, when used in combination with the available clinical information, it can be used for determining whether bringing in a transplant recipient into a medical facility is necessary. CONCLUSIONS: In the event COVID-19 becomes a long-term challenge for our community, noninvasive biomarkers such as the dd-cfDNA may become more relevant than ever in enhancing our ability to care for our transplant patients while maximizing the distancing measures.