Triple infection with disseminated tuberculosis, invasive aspergillosis and COVID-19 in an organ transplant recipient with iatrogenic immunosuppression.
BMJ Case Rep
; 14(8)2021 Aug 10.
Article
in English
| MEDLINE | ID: covidwho-1352548
ABSTRACT
A 39-year-old man with diabetes mellitus and hypertension presented two years following renal transplantation with evening pyrexia, night sweats and loss of weight. He was diagnosed with disseminated tuberculosis and invasive aspergillosis and commenced on antituberculous and antifungal therapy. Immunosuppressants except for the maintenance dose of steroids were discontinued. Two weeks later, he acquired severe COVID-19 pneumonia complicated with type 1 respiratory failure and haemodynamic instability. He was treated with non-invasive ventilation and inotropic support with a vasopressor-augmenting dose of steroids. Management challenges were diagnosing the respiratory pathologies with limited investigations, deciding on continuation of steroids in an organ transplant recipient with disseminated infection and deciding the ceiling of care in a low-resource setting given the background of multiple pulmonary insults. A multidisciplinary team decided to continue high-dose steroids and escalate to a full ceiling of care. He recovered from COVID-19 pneumonia 15 days following diagnosis and was discharged home. The potential adverse effects of steroids on tuberculosis and aspergillosis are to be monitored during follow-up.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Aspergillosis
/
Kidney Transplantation
/
COVID-19
Type of study:
Case report
/
Cohort study
/
Diagnostic study
/
Prognostic study
Limits:
Adult
/
Humans
/
Male
Language:
English
Year:
2021
Document Type:
Article
Affiliation country:
Bcr-2021-245131
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