Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 18, 2022; 12(4): 72-78
Published online Apr 18, 2022. doi: 10.5500/wjt.v12.i4.72
Potential importance of early treatment of SARS-CoV-2 infection in intestinal transplant patient: A case report
Mathias Clarysse, Laurens J Ceulemans, Lucas Wauters, Nicholas Gilbo, Viktor Capiau, Gert De Hertogh, Wim Laleman, Chris Verslype, Diethard Monbaliu, Jacques Pirenne, Tim Vanuytsel
Mathias Clarysse, Nicholas Gilbo, Diethard Monbaliu, Jacques Pirenne, Department of Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Mathias Clarysse, Laurens J Ceulemans, Lucas Wauters, Nicholas Gilbo, Diethard Monbaliu, Jacques Pirenne, Tim Vanuytsel, Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Mathias Clarysse, Nicholas Gilbo, Diethard Monbaliu, Jacques Pirenne, Laboratory of Abdominal Transplant Surgery, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Laurens J Ceulemans, Department of Thoracic Surgery, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Laurens J Ceulemans, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Lucas Wauters, Wim Laleman, Chris Verslype, Tim Vanuytsel, Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Lucas Wauters, Tim Vanuytsel, Translational Research Center for Gastrointestinal Disorders (TARGID), Department Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Viktor Capiau, Gert De Hertogh, Department of Pathology, University Hospitals Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Gert De Hertogh, Laboratory of Translational Cell & Tissue Research, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Chris Verslype, Laboratory of Clinical Digestive Oncology, Department of Digestive Oncology, KU Leuven, Leuven 3000, Vlaams-Brabant, Belgium
Author contributions: Clarysse M contributed review of the clinical case, review of literature, and drafting of the article; Ceulemans LJ contributed critical review of literature and the article; Wauters L, Gilbo N, Capiau V, and De Hertogh G contributed review of clinical case and critical review of article; Verslype C, Laleman W, Monbaliu D, and Pirenne J contributed critical review of the article; Vanuytsel T contributed review of the clinical case, review of literature, and review of the article; All authors issued final approval for the version to be submitted.
Informed consent statement: Study participant provided informed written consent, prior to study enrollment, and after ethical approval from the University Hospitals Leuven institutional review board (S64844).
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose in relation to this study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tim Vanuytsel, MD, MSc, PhD, Associate Professor, Doctor, Senior Researcher, Leuven Intestinal Failure and Transplantation Center (LIFT), University Hospitals Leuven, Herestraat 49, Leuven 3000, Vlaams-Brabant, Belgium. tim.vanuytsel@uzleuven.be
Received: June 1, 2021
Peer-review started: June 1, 2021
First decision: September 2, 2021
Revised: September 13, 2021
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: April 18, 2022
Abstract
BACKGROUND

Predispositions for severe coronavirus disease 2019 (COVID-19) are age, immunosuppression, and co-morbidity. High levels of maintenance immunosuppression render intestinal transplant (ITx) patients vulnerable for severe COVID-19. COVID-19 also provokes several gastroenterological pathologies which have not been discussed in ITx, so far.

CASE SUMMARY

During the second European COVID-19 wave in November 2020, an ITx recipient was admitted to the hospital because of electrolyte disturbances due to dehydration. Immunosuppression consisted of tacrolimus, azathioprine, and low-dose corticosteroids. During hospitalization, she tested positive on screening COVID-19 nasopharyngeal polymerase chain reaction swab, while her initial test was negative. She was initially asymptomatic and had normal inflammatory markers. Tacrolimus levels were slightly raised, as Azathioprine was temporarily halted. Due to elevated D-dimers at that time, prophylactic low-molecular weight heparin was started. Seven days after the positive test, dyspnea, anosmia, and C-reactive protein increase (25 mg/L) were noted. Remdesivir was administered during 5 d in total. High stomal output was noted in two consecutive days and several days thereafter. To exclude infection or rejection, an ileoscopy and biopsy were performed and excluded these. Four weeks later, she was discharged from the hospital and remains in good health since then.

CONCLUSION

Early eradication of severe acute respiratory syndrome coronavirus 2 in ITx recipients may be warranted to prevent acute rejection provocation by it.

Keywords: COVID-19, Intestinal transplantation, Outcome, SARS-CoV-2, Treatment, Case report

Core Tip: Acute rejection is often seen in intestinal transplant (ITx) recipients due to the high immunogenicity of the intestinal graft. However, it might also be provoked by latent presence of viruses, due to the high immunosuppression needs. Recently, chronic latency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the intestine has been shown. Hence, early recognition, eradication, and follow-up on intestinal biopsies in ITx recipients might be warranted to prevent the potential acute rejection provocation of the intestinal graft by SARS-CoV-2.