Immunosuppressants

Abstract

Haematological disorders and COVID-19: 2 case reports In a case report, two men were described, of whom a 47-year-old man developed thrombocytopenia, leukopenia, lymphopenia and COVID-19 infection during immunosuppressive treatment with mycophenolate sodium and tacrolimus, and a 54-year-old man developed lymphopenia and COVID-19 infection during immunosuppressive treatment with mycophenolate mofetil and tacrolimus [routes and times to reaction onsets not stated]. This report describes a 47-year-old man (case 1): The man, who had with Chagas disease, had undergone heart transplantation on 08 August 2012. He had been receiving immunosuppressive treatment with mycophenolate sodium 1440 mg/day and tacrolimus 4 mg/day. On 12 April 2020, he developed fever, headache, myalgia, mild dyspnoea, dry cough, anosmia and diarrhoea. He was living in a community with confirmed cases of COVID-19. On 14 April 2020 (on day 3 of symptom onset), he sought emergency care. On physical examination, he was found to be feverish without haemodynamic instability. Arterial blood gases showed mild hypoxia. Investigations showed trombocytopenia, leukopenia and lymphopenia. Chest CT scan showed lung abnormalities. RT-PCR SARS-COV2 test for the collected nasopharyngeal secretion was found to be positive and he was diagnosed with COVID-19. He was hospitalised. His therapy with mycophenolate sodium was stopped due to thrombocytopenia, leukopenia and lymphopenia, while tacrolimus was maintained. Prophylactic anticoagulation with unspecified drug was also started. On day 6 of symptom onset, he remained clinically stable. He had fever with consolidation in the right haemithorax, and intensification of the ground glass opacification in the left haemithorax. A bacterial pneumonia was also considered; therefore, he was started on azithromycin and ceftriaxone. On day 6 of the hospitalisation, the serum tacrolimus level was 4.3 ng/dL, and the dose of tacrolimus was adjusted. His fever persisted. A CT scan showed disease progression, with impairment of <50% of the lung parenchyma. Off-label hydroxychloroquine was started for COVID-19. On the same day, leukopenia, lymphopenia and thrombocytopenia improved; hence, mycophenolate sodium was restarted. On day 12 of the hospitalisation, he was discharged with asymptomatic status. This report describes a 54-year-old-man (case 2): The man with dilated idiopathic cardiomyopathy, underwent heart transplantation on 03 August 2012. He had been receiving immunosuppressive treatment with tacrolimus 2 mg/day and mycophenolate mofetil 1000 mg/day. On 11 May 2020, he had fever, dry cough, lack of appetite and asthenia. His daughter had the same symptoms. On 13 May 2020 (day 3 of symptom onset), he sought emergency care. Physical examination showed no fever or haemodynamic instability. Investigations showed lymphopenia. Chest CT scan showed lung abnormalities. RT-PCR SARS-COV2 test for the collected nasopharyngeal secretion was found to be inconclusive. Based on clinical and radiological parameters, COVID-19 was considered,...