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A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease.
Am J Nephrol. 2020; 51(5):337-342.AJ

Abstract

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA. Department of Medicine, Nephrology Section, Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA. Department of Medicine, Nephrology Section, Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA.Division of Infectious Diseases, University of California Irvine School of Medicine, Epidemiology and Infection Prevention Program, UC Irvine Health, Orange, California, USA.Division of Infectious Diseases, University of California Irvine School of Medicine, Epidemiology and Infection Prevention Program, UC Irvine Health, Orange, California, USA.Department of Medicine, Hospitalist Program, University of California Irvine Medical Center, Orange, California, USA.Department of Medicine, Hospitalist Program and Division of Infectious Disease, University of California Irvine Medical Center, Orange, California, USA.Department of Medicine, Division of Pulmonology and Critical Care, University of California Irvine Medical Center, Orange, California, USA.Department of Medicine, Division of Pulmonology and Critical Care, University of California Irvine Medical Center, Orange, California, USA.Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA, kkz@uci.edu. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA, kkz@uci.edu. Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA, kkz@uci.edu. Department of Medicine, Nephrology Section, Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA, kkz@uci.edu. Department of Medicine, Division of Pulmonology and Critical Care, University of California Irvine Medical Center, Orange, California, USA, kkz@uci.edu.

Pub Type(s)

Case Reports
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32222713

Citation

Ferrey, Antoney J., et al. "A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting With Gastroenteritis and Developing Severe Pulmonary Disease." American Journal of Nephrology, vol. 51, no. 5, 2020, pp. 337-342.
Ferrey AJ, Choi G, Hanna RM, et al. A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease. Am J Nephrol. 2020;51(5):337-342.
Ferrey, A. J., Choi, G., Hanna, R. M., Chang, Y., Tantisattamo, E., Ivaturi, K., Park, E., Nguyen, L., Wang, B., Tonthat, S., Rhee, C. M., Reddy, U., Lau, W. L., Huang, S. S., Gohil, S., Amin, A. N., Hsieh, L., Cheng, T. T., Lee, R. A., & Kalantar-Zadeh, K. (2020). A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease. American Journal of Nephrology, 51(5), 337-342. https://doi.org/10.1159/000507417
Ferrey AJ, et al. A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting With Gastroenteritis and Developing Severe Pulmonary Disease. Am J Nephrol. 2020;51(5):337-342. PubMed PMID: 32222713.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease. AU - Ferrey,Antoney J, AU - Choi,Grace, AU - Hanna,Ramy M, AU - Chang,Yongen, AU - Tantisattamo,Ekamol, AU - Ivaturi,Kaushik, AU - Park,Elisa, AU - Nguyen,Lawrence, AU - Wang,Brian, AU - Tonthat,Sam, AU - Rhee,Connie M, AU - Reddy,Uttam, AU - Lau,Wei Ling, AU - Huang,Susan S, AU - Gohil,Shruti, AU - Amin,Alpesh N, AU - Hsieh,Lanny, AU - Cheng,Timmy T, AU - Lee,Richard A, AU - Kalantar-Zadeh,Kamyar, Y1 - 2020/03/28/ PY - 2020/03/21/received PY - 2020/03/24/accepted PY - 2020/3/31/pubmed PY - 2020/5/19/medline PY - 2020/3/31/entrez KW - Acute respiratory distress syndrome KW - End-stage renal disease KW - Novel coronavirus disease 19 KW - Rennin-angiotensin-aldosterone system blockade KW - Viral sepsis SP - 337 EP - 342 JF - American journal of nephrology JO - Am J Nephrol VL - 51 IS - 5 N2 - Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/32222713/A_Case_of_Novel_Coronavirus_Disease_19_in_a_Chronic_Hemodialysis_Patient_Presenting_with_Gastroenteritis_and_Developing_Severe_Pulmonary_Disease_ L2 - https://www.karger.com?DOI=10.1159/000507417 DB - PRIME DP - Unbound Medicine ER -