Belatacept : Coronavirus disease 2019 (COVID-19): case report

Abstract

Author Information An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 58-year-old man developed COVID-2019 infections (COVID-19) during immunosuppressive treatment with belatacept. The man, who had a history of cured testicular cancer followed by renal vein thrombosis and coronary artery disease, had undergone kidney transplantation in January 2017. Due to ciclosporin-induced nephrotoxicity, ciclosporin had been replaced by belatacept in June 2017. His maintenance immunosuppressive treatment included belatacept infusion at 345mg every 28 days, mycophenolate mofetil and prednisone. The last dose of belatacept had been administered on 18 February 2020. Three weeks later (i.e. on 7 March 2020), he presented to a hospital with fever (38°C), mild dyspnoea and cough. These symptoms had developed 1 week after being in contact with a carrier of COVID-19. Consequently, he was hospitalised. The man's treatment with belatacept and mycophenolate mofetil was stopped on the day of admission. He was diagnosed with SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR) amplification of the RdRp viral gene from a nasopharyngeal swab specimen. On admission, his blood oxygen saturation on room air was 96% and remained stable during the hospitalisation period. Limited peripheral pulmonary groundglass opacities were identified on a chest CT scan. His serum interleukin 6 levels measured with a chemiluminescent enzyme assay were found to be markedly lower (29 ng/L) than those observed in the COVID-19 patients. As a result, he required mechanical ventilation. He had a mild clinical course according to the WHO interim guidance for COVID-19 with a rapid recovery of respiratory symptoms after treatment [details not stated] of a possible bacterial superinfection. On 25 March 2020, he was re-started on ciclosporin. After 5 days of discharge, he was free from fever, cough or breathing difficulties. His laboratory test results were in line with those observed before SARS-CoV-2 infection. A plan was made to withdraw ciclosporin and to restart both belatacept and mycophenolate mofetil on 14 April 2020, which was the next schedule of his belatacept infusion.