Presentation of SARS-CoV-2 in a Pediatric Heart Transplant Recipient with Multiple Underlying Comorbidities

Bibhuti Das

doi:10.3390/transplantology2010009

Abstract

A six-year-old heart transplant recipient with additional significant co-morbidities, including severe hypoxic-ischemic injury, gastrostomy, tracheostomy, and mechanical ventilation dependency, encountered SARS-CoV-2 infection. The patient received tacrolimus and mycophenolate to prevent graft rejection, presented initially with SARS-CoV-2 positive and presumed pseudomonas aeruginosa pneumonia. Twenty-three days later, the patient presented with fever recurrence with evidence for systemic inflammation, which resolved rapidly with high-dose methylprednisolone. Interestingly, while IgM to SARS-CoV-2 was present, IgG was not detected even three months after his first positive test for SARS-CoV-2. The author discusses potential immune mechanisms that might have affected the course of multi-system inflammatory syndrome children (MIS-C) in this patient.

Highlights

There is little data on clinical characteristics and outcomes with SARS-CoV-2 infection in children and adults with an immunocompromised status after heart transplantation [1,2,3,4,5].Higher mortality was associated with COVID-19 in adult transplant recipients with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers [5]
A six-year-old boy was diagnosed with left ventricular noncompaction cardiomyopathy with severe heart failure and underwent heart transplantation at nine months
His postoperative course was complicated by severe hypoxic-ischemic injury, gastrostomy, and tracheostomy, and he remained on mechanical ventilation

Summary

Introduction

There is little data on clinical characteristics and outcomes with SARS-CoV-2 infection in children and adults with an immunocompromised status after heart transplantation [1,2,3,4,5]. A six-year-old boy was diagnosed with left ventricular noncompaction cardiomyopathy with severe heart failure and underwent heart transplantation at nine months His postoperative course was complicated by severe hypoxic-ischemic injury, gastrostomy, and tracheostomy, and he remained on mechanical ventilation. His tracheal aspirate for aspergillus filament and pneumocystis carinii were negative He was admitted to the hospital for supportive care and treated with intravenous Imipenem, and discharged home to complete a ten-day course with oral Ofloxacin. Transplantology 2021, 2 for supportive care and treated with intravenous Imipenem, and discharged home to complete a ten-day course with oral Ofloxacin Both were quarantined at home as per the center for disease control (CDC) guidelines

His tested negative for positive

Second CXR

The differential

Hisimmunosuppression tacrolimus trough level was and

He became finallymagnetic