Renal Transplant Recipient with Concurrent COVID-19 and Stenotrophomonas maltophilia Pneumonia Treated with Trimethoprim/Sulfamethoxazole Leading to Acute Kidney Injury: A Therapeutic Dilemma

Abstract

Patient: Male, 64-year-old Final Diagnosis: COVID-19 pneumonia Symptoms: Cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Pulmonology Objective: Rare co-existance of disease or pathology Background: Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfa-methoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S . maltophilia pneumonia. Case Report: A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient’s clinical deterioration and ultimate death. Conclusions: The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.

SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020

“…1 . Most included studies were case reports (n=89) [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] ...…”

Treatment refractoryStenotrophomonas maltophiliabacteraemia and pneumonia in a COVID-19-positive patient

“… 11 S. maltophilia post viral superinfection has been documented in immunosuppressed patients. 10 Our patient had also been diagnosed with COVID-19 pneumonia, which in some cases has led to temporary immunosuppression while the virus is active, potentially predisposing our patient to more severe bacterial illness. Necrotising S. maltophilia pneumonia is a serious complication, and despite appropriate therapy, many patients may die because of progressive infection.…”

“…The primary risk factor for SBI is severe COVID-19 pneumonia on admission, and SBI was associated with increased mortality at 49% during hospitalisation. [8][9][10] Regarding S. maltophilia infection, some key issues complicate treatment with TMP-SMX, especially in the ICU setting.…”

“…To our knowledge, there are only 12 reported cases in the literature documenting concomitant S. maltophilia and COVID-19 infection, of which all cases were of S. maltophilia pneumonia. [8][9][10] Our case represents the first reported case of S. maltophilia pneumonia with concomitant bacteraemia in a COVID-19positive patient.…”

Antibacterial, Docking, DFT and ADMET Properties Evaluation of Chalcone-Sulfonamide Derivatives Prepared Using ZnO Nanoparticle Catalysis

“… 19 Among them, sulfamethoxazole has been the first-line treatment for pneumonia. 28 Therefore in the present study, we have elucidate the molecular docking interaction between the synthesized compounds against E. Coli dihydropteroate synthase and compared with the clinical drugs (sulfamethoxazole). The synthesized compounds ( 6 – 9 ) were found to have minimum binding energy ranging from –6.6 to –8.2 kcal/mol ( Table 3 ), with the best result achieved using compound 8 (–7.8 kcal/mol), and 9 (–8.2 kcal/mol).…”