PubMed:32378314 JSONTXT 2 Projects

Early Experience of COVID-19 in Two Heart Transplant Recipients: Case Reports and Review of Treatment Options. The Coronavirus Disease 2019 (COVID-19) pandemic imposes special challenges to immunocompromised transplant patients. Given the paucity of proven data in treating COVID-19, management of these patients is difficult, rapidly evolving, and is mainly based on anecdotal experience. We report 2 cases of heart transplant (HT) recipients with COVID-19. The first is a 59-year-old female with HT in 2012 who presented on March 20, 2020 with fever, hypoxia and ground-glass opacities on chest x-ray. She quickly progressed to acute hypoxic respiratory failure and vasoplegic shock. Despite reduction in immunosuppression, and treatment with tocilizumab, intravenous immunoglobulin, hydroxychloroquine, lopinavir/ritonavir and broad-spectrum antibiotics, she ultimately passed away from multiorgan failure. The second case is a 75-year-old man with HT in 2000 who presented on April 2, 2020 after curbside testing revealed positive COVID-19. Given a milder presentation compared to the first patient, antimetabolite was discontinued and only hydroxychloroquine was started. Due to lack of clinical improvement several days later, tocilizumab, methylprednisolone, and therapeutic anticoagulation were initiated. The patient clinically improved with decreasing oxygen requirements and was discharged home. These two cases highlight the wide range of different presentations of COVID-19 in HT recipients, and the rapidity with which the management of these patients is evolving.