A 66-year-old man that underwent a right lung transplant in 2016 for chronic obstructive pulmonary disease, immunosuppressed with tacrolimus, mycophenolate mofetil (MMF) and prednisolone 5 mg per day, presented to the Emergency Department with fever and dyspnea 10 days after a positive SARS-CoV-2 PCR. MMF was discontinued and prednisolone dose was increased to 20 mg per day. He had normal graft function and a second COVID-19 vaccine dose two months prior. Intensive Care admission was needed due to respiratory failure. Computed tomography (CT) scan revealed ground-glass consolidations affecting 25–50% of the transplanted lung (Fig. 1), which evolved to more than 75% two days later (Fig. 2), and only emphysema in the left lung. High-flow nasal oxygen, noninvasive ventilation and methylprednisolone 1 mg per kg (5 days) were instituted. Clinical improvement permitted discharge after 14 days, with ambulatory oxygen. Six weeks later, CT scan showed full resolution of pneumonia, but FEV1 declined (52%–42%). In single-lung transplant recipients, COVID-19 radiologic findings can be atypical. [1, 2] Transplanted lung exclusive involvement may suggest an individual predisposing factor to severe disease.
Messika J, Eloy P, Roux A, Hirschi S, Nieves A, Le Pavec J, et al.: COVID-19 in lung transplant recipients. Transplantation 2021; 105(1): 177–186.
Myers CN, Scott JH, Criner GJ, Cordova FC, Mamary AJ, Marchetti N, et al.: COVID-19 in lung transplant recipients. Transpl Infect Dis 2020; 22(6): e13364.