TY - JOUR
T1 - Renal transplant recipient with concurrent COVID-19 and stenotrophomonas maltophilia pneumonia treated with trimethoprim/ sulfamethoxazole leading to acute kidney injury
T2 - A therapeutic dilemma
AU - Mohamed, Mohamed A.
AU - Kaur, Jasleen
AU - Wani, Farah
AU - Kichloo, Asim
AU - Bhanot, Ravinder
N1 - Publisher Copyright:
© Am J Case Rep, 2020.
PY - 2020
Y1 - 2020
N2 - 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 nos-ocomial 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 ad-mission. 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 mul-tifactorial. 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.
AB - 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 nos-ocomial 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 ad-mission. 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 mul-tifactorial. 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.
KW - COVID-19
KW - Kidney Transplantation
KW - MeSH Acute Kidney Injury
KW - Stenotrophomonas maltophilia
KW - Trimethoprim-Sulfamethoxazole Combination
UR - http://www.scopus.com/inward/record.url?scp=85089549995&partnerID=8YFLogxK
U2 - 10.12659/AJCR.926464
DO - 10.12659/AJCR.926464
M3 - Article
C2 - 32799217
AN - SCOPUS:85089549995
VL - 21
SP - 1
EP - 5
JO - American Journal of Case Reports
JF - American Journal of Case Reports
SN - 1941-5923
M1 - e926464
ER -