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Introduction: Infection with SARS-CoV-2 increases the risk of acute graft dysfunction (AGD) in renal transplant recipients (RTR), and the risk of concurrently presenting with opportunistic infections is also increased. There is no current consensus on the management of immunosuppression during SARS-CoV-2 infection in RTR. Case Presentation. A 35-year-old male RTR from a living related donor presented with SARS-CoV-2 infection (January 2021). Two months later, despite alterations to his immunosuppression regimen (tacrolimus (TAC) was reduced by 50%, and the mycophenolic acid (MMF) was suspended with the remission of symptoms), the patient presented with pulmonary tuberculosis, pneumonia due to respiratory syncytial virus (RSV), cytomegalovirus (CMV) pneumonitis, and histoplasmosis (HP). Management was initiated with antituberculosis medications, ganciclovir, antibiotics, and liposomal amphotericin B, and the immunosuppressants were suspended, yet the patient's evolution was catastrophic and the outcome fatal. Conclusion: We recommend that in RTR post-COVID-19, the immunosuppression regimen should be gradually reinstated along with strict vigilance in observing for highly prevalent coinfections (TB, HP, and CMV).
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Introducción y objetivo: Cambios moleculares en el gen CTLA-4 pueden modificar la habilidad para controlar la proliferación de los linfocitos T, y promover la persistencia o eliminación del virus de la hepatitis C (VHC). Nuestro objetivo fue investigar la frecuencia y asociación de los polimorfismos −319 C/T y +49 A/G del gen CTLA-4, en pacientes con infección por VHC. Métodos: Los polimorfismos del gen CTLA-4 (−319 C/T en la región promotora y +49 A/G en el exón 1) fueron analizados por T-ARMS-PCR en 420 individuos, incluidos 205 pacientes con infección crónica por VHC y 215 sujetos sanos. Resultados: Se encontró una asociación positiva del alelo +49G con la infección por VHC (OR 1,48; IC 95% 1,09-2,02; p=0,02), y con el sexo masculino (OR 1,80; IC 95% 1,16-2,79; p=0,02), ambos en enfermedad crónica (sin cirrosis). Se observaron diferencias significativas en la distribución de los genotipos del polimorfismo +49 A/G, entre los pacientes con infección por VHC y los sujetos sanos en un modelo genético dominante (GG+GA frente a AA; OR1,57; IC 95% 1,05-2,33; p=0,04). No se observaron diferencias en las frecuencias del polimorfismo −319 C/T, entre pacientes con VHC y sujetos sanos. El haplotipo -319C/+49G confiere susceptibilidad a la infección por el genotipo 3 del VHC (OR 10,68; IC 95% 1,17-96,97; p=0,04). Conclusiones: El alelo +49G confiere susceptibilidad a infección por VHC y a infección en el sexo masculino, ambos en enfermedad crónica. Además, el haplotipo -319C/+49G confiere susceptibilidad a la infección por el genotipo 3 del VHC. Nuestros resultados evidencian una implicación importante de los polimorfismos −319 C/T y +49 A/G en la infección por VHC
Introduction and objective: Molecular changes in the CTLA-4 gene can modify the ability to control T lymphocyte proliferation, and promote the persistence or elimination of the hepatitis C virus (HCV). We aimed to investigate the frequency and association of -319 C/T and +49 A/G polymorphism in the CTLA-4 gene in patients infected with HCV. Methods: The CTLA-4 gene polymorphisms (-319 C/T in the promoter region, and +49 A/G in exon 1) were analysed by T-ARMS-PCR in 420 individuals, including 205 chronic HCV infected patients and 215 healthy subjects. Results: We found a positive association of +49G allele with HCV infection (OR 1.48; 95% CI 1.09-2.02; p=.02), and with males (OR 1.80; 95% CI 1.16-2.79; p=.02), both in chronic disease (without cirrhosis). Also, significant differences in +49 A/G genotypes distribution between HCV infected patients and healthy subjects were shown in a dominant genetic model (GG+GA versus AA; OR 1.57; 95% CI 1.05-2.33; p=.04). No significant differences were observed in the -319 C/T polymorphism between HCV infected patients and healthy subjects. Moreover, -319C/+49G haplotype confers susceptibility to HCV genotype 3 infection (OR 10.68; 95% CI 1.17-96.97; p=.04). Conclusions: The +49G allele confers susceptibility to HCV infection and with male gender, both in chronic disease. In addition, the −319C/+49G haplotype confers susceptibility to HCV genotype 3 infection. Our results support an important role of the −319 C/T and +49 A/G polymorphisms in HCV infection
