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.
American journal of nephrology. 2020 Mar 28 [Epub ahead of print]
Antoney J Ferrey, Grace Choi, Ramy M Hanna, Yongen Chang, Ekamol Tantisattamo, Kaushik Ivaturi, Elisa Park, Lawrence Nguyen, Brian Wang, Sam Tonthat, Connie M Rhee, Uttam Reddy, Wei Ling Lau, Susan S Huang, Shruti Gohil, Alpesh N Amin, Lanny Hsieh, Timmy T Cheng, Richard A Lee, Kamyar Kalantar-Zadeh
Department of Medicine, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, 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 Nephrology, Hypertension and Kidney Transplantation, University of California Irvine Medical Center, Orange, California, USA, .