Successful treatment of a kidney transplant patient with COVID-19 and late-onset Pneumocystis jirovecii pneumonia

Abstract

Background Solid transplant patients are susceptible to Pneumocystis jirovecii pneumonia (PJP). While the vast majority of PJP cases occur within the first 6 months after transplantation, very few PJP cases are seen beyond 1 year post-transplantation (late-onset PJP). PJP and coronavirus disease 2019 (COVID-19, caused by infection with SARS-CoV-2) share quite a few common clinical manifestations and imaging findings, making the diagnosis of PJP often underappreciated during the current COVID-19 pandemic. To date, only 1 case of kidney transplantation who developed COVID-19 and late-onset PJP has been reported, but this patient also suffered from many other infections and died from respiratory failure and multiple organ dysfunction syndrome. A successful treatment of kidney patients with COVID-19 and late-onset PJP has not been reported. Case presentation We present a case of a 55-year-old male kidney transplant patient with COVID-19 who also developed late-onset PJP. He received a combined treatment strategy, including specific anti-pneumocystis therapy, symptomatic supportive therapy, adjusted immunosuppressive therapy, and use of antiviral drugs/antibiotics, ending with a favorable outcome. Conclusions This case highlights the importance of prompt and differential diagnosis of PJP in kidney transplant patients with SARS-CoV-2 infection. Further studies are required to clarify if kidney transplant patients with COVID-19 could be prone to develop late-onset PJP and how these patients should be treated.

Pneumocystis jiroveciiInfections Among COVID-19 Patients: A Case Series and Literature Review

“…The median absolute lymphocyte count from the literature review including our cases (IQR) was 0.6 (0.26–0.86) ×10 3 cells/mm 3 . However, we could only verify described lymphopenia at the time of COVID-19 diagnosis in 7 patients compared with the 25 cases identified with lymphopenia at the time of PCP diagnosis [ 5 , 7 , 8 , 10 , 11 , 14 , 16 , 17 , 21 , 35 , 36 ]. Our case series findings support lymphopenia as a possible risk factor for PCP in the setting of COVID-19 infection.…”

Pneumocystis jirovecii in solid organ transplant recipients: updates in epidemiology, diagnosis, treatment, and prevention

“…Prior respiratory viral infection COVID-19 and increased prevalence of PJP in non-HIV patients without HIV [75]; postrenal transplant [76,77].…”

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…There have been approximately 100 reports of coinfection of P. jirovecii in COVID-19 patients, with some of them reviewed recently by Gioia et al [ 226 ] and Khodadadi et al [ 227 ]. The largest number of coinfection cases (in non-HIV/AIDS) was reported from France (34 cases), followed by Italy (22 cases) and Pakistan (10 cases) ( Figure 3 and Table S3 [ 15 , 224 , 225 , 226 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 ]).…”