肾移植术后感染新型冠状病毒1例

Severe acute respiratory syndrome coronavirus 2 infection in renal transplant recipients:A case report

1病例资料患者女性,37岁,主因“发热伴咳嗽8日”于2020年2月13日入院。入院前8天(2月5日),患者无明显诱因出现发热,夜间体温最高达40℃,伴畏寒,寒战,干咳,无痰,有轻度呼吸困难,活动后明显,肌肉酸痛,头痛,头晕,纳差,胸痛,胸闷,咽痛,无乏力和盗汗,遂于武汉协和医院就诊,胸部CT提示左下肺多发斑片磨玻璃影(图1),鼻咽拭子新型冠状病毒(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)核酸检测呈阳性。

The novel coronavirus is a newly discovered pathogen in late December 2019,and its source is currently unknown,which can lead to asymptomatic infection,new coronavirus pneumonia or serious complications,such as acute respiratory failure.Corona virus disease 2019(COVID-19)is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus.Its common symptoms are highly similar to those of other viruses,such as fever,cough and dyspnea.There is currently no vaccine or treatment for COVID-19.Everyone is susceptible to infection with this disease,and owing to the long-term use of immunosuppressants,the immunity of kidney transplant recipients is suppressed,and it is more likely to be infected with the disease.At present,its impact on kidney transplant recipients is unclear.This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation.A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia.The patient’s symptoms(such as fever,chills,dry cough,muscle aches),laboratory tests(such as decreased white blood cell count,elevated liver enzymes and D-dimer,positive viral nucleic acid test),and chest CT(multiple left lower lung plaque ground glass shadow)were similar to those of non-transplanted novel coronavirus pneumonia patients.In terms of treatment,because the immunity of kidney transplant recipients has been suppressed for a long time,it is a very common strategy to suspend the use of immunosuppressive agents.Therefore,the patient immediately discontinued the immunosuppressive agent after admission,so that she could restore immunity against infection in a short time.At the same time,the use of glucocorticoids was also very important.Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition,prophylactic antibiotics was needed,and nephrotoxic drugs should be used with caution.Finally,following discounting the use of immunosuppressant and a low-dose glucocorticoidbased treatment regimen,COVID-19 in this renal transplant recipient was successfully cured.The cure of this case was of great significance,and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.