*3.2. Renal Transplant Recipients*

There are three case reports describing a COVID-19 with stages IIA and IIB (Table 1) [21,22,24]. In the case report by Guillen et al., the first patient was a 50-year-old man under tacrolimus, everolimus and prednisone therapy [22]. He presented to the hospital with fever and vomiting, without other symptoms. After 5 days, the patient, who initially was sent home, returned to the emergency department with persistent fever and cough, but without gastrointestinal symptoms. At that time, he was afebrile and had a normal oxygen saturation. Because of a unilateral infiltrate on chest X-ray (CXR), a community-acquired pneumonia was considered. However, he tested positive on naso- and oropharyngeal swabs for SARS-CoV-2. He was treated with lopinavir/ritonavir, but worsened clinically with disease progression on CXR showing bilateral infiltrates, requiring intubation with mechanical ventilation. The final outcome of the patient has not yet been communicated.

Zhu et al. [21] described a 52-year-old man on immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and prednisone. He presented with fatigue, dyspnea, chest tightness, chest pain, nausea, loss of appetite, intermittent abdominal pain and occasional dry cough. He developed fever and the chest CT showed bilateral ground-glass opacities, suggesting the presence of COVID-19 pneumonia. Immunosuppression was completely stopped, and treatment with methylprednisolone (40 mg daily, intravenously), intravenous immunoglobulins (5 g on the first day and 10 g/day for the next 11 days), biapenem, pantoprazole, and Interferon (IFN)-α (5 million units daily by atomization inhalation) was started. A follow-up chest CT showed massive improvement later, and the patient was finally discharged from hospital.

Gandolfini et al. [24] described two stage IIB COVID-19 renal transplant cases requiring non-invasive ventilation. Both patients were on tacrolimus, steroids and mycophenolate mofetil, presenting with fever and dyspnea on admission, with CT showing bilateral ground-glass opacities. The first patient developed abrupt worsening of his respiratory conditions and died 5 days after admission to the hospital, before he could be intubated. The second patient was stabilized and treated with colchicine after initially receiving retroviral therapy and hydroxychloroquine.
