Premium
Allograft infiltration and meningoencephalitis by SARS‐CoV‐2 in a pancreas‐kidney transplant recipient
Author(s) -
Westhoff Timm H.,
Seibert Felix S.,
Bauer Frederic,
Stervbo Ulrik,
Anft Moritz,
Doevelaar Adrian A. N.,
Rohn Benjamin J.,
Winnekendonk Guido,
Dittmer Ulf,
Schenker Peter,
Vonbrunn Eva,
Amann Kerstin,
Viebahn Richard,
Babel Nina
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16223
Subject(s) - medicine , meningoencephalitis , pancreas , infiltration (hvac) , kidney , covid-19 , pathology , kidney transplantation , virology , infectious disease (medical specialty) , disease , physics , thermodynamics
Severe acute respiratory syndrome corona virus 2 (SARS‐CoV‐2) preferentially affects epithelia of the upper and lower respiratory tract. Thus, impairment of kidney function has been primarily attributed until now to secondary effects such as cytokine release or fluid balance disturbances. We provide evidence that SARS‐CoV‐2 can directly infiltrate a kidney allograft. A 69‐year‐old male, who underwent pancreas‐kidney transplantation 13 years previously, presented to our hospital with coronavirus disease 2019 (COVID‐19) pneumonia and impaired pancreas and kidney allograft function. Kidney biopsy was performed showing tubular damage and an interstitial mononuclear cell infiltrate. Reverse transcriptase polymerase chain reaction from the biopsy specimen was positive for SARS‐CoV‐2. In‐situ hybridization revealed SARS‐CoV‐2 RNA in tubular cells and the interstitium. Subsequently, he had 2 convulsive seizures. Magnetic resonance tomography suggested meningoencephalitis, which was confirmed by SARS‐CoV‐2 RNA transcripts in the cerebrospinal fluid. The patient had COVID‐19 pneumonia, meningoencephalitis, and nephritis. SARS‐CoV‐2 binds to its target cells through angiotensin‐converting enzyme 2, which is expressed in a broad variety of tissues including the lung, brain, and kidney. SARS‐CoV‐2 thereby shares features with other human coronaviruses including SARS‐CoV that were identified as pathogens beyond the respiratory tract as well. The present case should provide awareness that extrapulmonary symptoms in COVID‐19 may be attributable to viral infiltration of diverse organs.