Ligia Espinoso Schtruk et al. Jacqueline Miranda Vitor Salles Ana Sales … Luciana Lobbe Vaisnava Cavalcante Elisangela Reis Sharon Kugel Bruno Marques Gabrielle Carvalho Ruth Maia Filipe Oliveira dos Reis Danielle Rodrigues
Case Report
Case 1: 47-year-old male, Caucasian, with Chagas’ Disease, heart transplantation on 08/08/2012, without comorbidities, using tacrolimus (4 mg/day), sodium mycophenolate (1440 mg/day).
On 04/12/2020, he had myalgia, fever, headache, mild dyspnea, dry cough, diarrhea and anosmia. He lives in a community with confirmed cases of COVID-19. On 04/14/2020 (D3 of symptoms) he sought emergency care. Physical examination: feverish (axillary T: 38ºC), without hemodynamic instability (BP: 100 x 60 mmHg, HR: 60 bpm), borderline oxygen saturation (SpO2: 93%). Arterial blood gases showed mild hypoxia. Other exams are shown in . Chest computed tomography (CT) was performed on admission, and showed a bilateral ground-glass image, with a multilobar distribution, predominantly peripheral, with a crazy paving pattern, associated with foci and areas of consolidation, located in the lower lobes, <25% involvement (). Nasopharyngeal secretion was collected for RT-PCR SARS-COV2 test, which was positive. The patient was hospitalized. Sodium mycophenolate was suspended (thrombocytopenia/leukopenia), tacrolimus was maintained, and prophylactic anticoagulation prescription was started. On the 3rd day of hospitalization (D6 of symptoms), the patient remained clinically stable (94% SatO2), with fever and worsening of the radiological image, with consolidation in the right hemithorax, and intensification of the ground glass opacification in the left hemithorax (). Azithromycin (500 mg/d – 5 days) and Ceftriaxone (2 g/day- 7 days) were started. On the 6th day of hospitalization, the serum tacrolimus level was 4,3 ng/dL, and the dose was adjusted. On the 6th day of hospitalization (D9 of symptoms), the fever persisted. A CT scan showed disease progression, with impairment of <50% of the lung parenchyma (). Hydroxychloroquine was started (dose of 400 mg 12/12h 1st/day, 400mg/day- 4 days). On the 6th day of hospitalization, leukopenia/lymphopenia/thrombocytopenia improved, and mycophenolate sodium was reintroduced. On this date, an increase in D-dimer levels was observed (<500 ug/L to 2.270 ug/L). Vascular Doppler of lower limbs did not show any alterations. He was discharged on the 12th day of hospitalization, being asymptomatic. Laboratory tests are shown in .
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